<p>A teenage male with severe motor and intellectual disabilities was referred for evaluation of an esophageal mass detected on computed tomography(CT). Because the patient was nonverbal, the cause of the lesion and the possibility of foreign body ingestion were unclear. CT demonstrated a spherical lesion with fat-equivalent attenuation in the upper esophagus, but material composition and procedural safety were not determined. Ultrasonography, performed for further assessment, revealed a well-circumscribed spherical intraluminal lesion without internal vascularity. Comparative ultrasonographic evaluation using spherical objects of similar size showed that metallic and glass materials produced characteristic reverberation artifacts that were absent in the lesion, suggesting a non-metallic composition. This information supported clinical decision-making regarding removal strategy. The foreign body was successfully removed using a combined endoscopic and surgical approach. This case highlights the role of ultrasonography in evaluating esophageal foreign bodies and estimating material properties when other imaging modalities are limited.</p>