Introduction: The child presented from the outpatient clinic for a chest X-ray with a history of chronic cough. (Figure 1: A Chest X-Ray with Unusual Opacity in the Midline Behind the Heart)Method: The chest X-ray showed the unexpected radiographic appearance of a well-defined circular opacity with “eyes” like a smiley face projected behind the heart, highly suggestive of a swallowed object or foreign body aspiration. On questioning, the parents denied any history of recent foreign body ingestion or choking and were unaware of any event that could explain the radiographic findings.On review of the patient’s medical records, it was established that the child had a transcatheter closure device implanted in another hospital for an atrial septal defect. The circular “smiley face” seen on the chest X-ray was not a foreign body but the closure device replicating a smiley face.Conclusion: While foreign body aspiration is a common consideration in paediatric patients, this case highlights the importance of considering a patient’s medical history when interpreting radiographic findings to prevent unnecessary procedures and parental anxiety. Children with congenital heart disease and implanted devices can have unusual radiographic appearances of radiopaque devices that might mimic foreign bodies.
