Migrating fish bone presenting as acute onset of neck lump.
We encountered a 62-year-old woman with a progressively worsening sore throat and a sharp lump located in her left upper neck, which appeared several hours before admission. After questioning, she underwent rigid esophagoscopy at a local hospital for suspected fish bone impaction but this gave a negative result. Unusual signs caused us to arrange a computed tomography scan, which showed that a foreign body had penetrated the left sternocleidomastoid muscle to the subcutaneous layer, with extensive emphysema in the neck. We extracted the foreign body with a 1-cm horizontal incision of the neck under general anesthesia. The patient returned to a normal diet and was discharged on day 5 of hospitalization without further morbidity. This is another rare case of a migrating foreign body presenting as a neck lump. On reviewing the literature, most cases involving subcutaneously migrating fish bones show development of a neck lump several weeks to months after ingestion, with relatively stable conditions. However, our case showed a neck lump 1 day after ingestion with acute toxic symptoms.
Wang
Ching-Ping
CP
Department of Otolaryngology, Taichung Veterans General Hospital, National Yang-Ming University, Taichung, Taiwan. entcpw@gmail.com
Jiang
San-Ling
SL
D000208:Acute Disease; D000818:Animals; D001842:Bone and Bones; D003937:Diagnosis, Differential; D004945:Esophagoscopy; D005260:Female; D005399:Fishes; D005548:Foreign-Body Migration / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging / Q000601:surgery; D019838:Neck Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D017747:Seafood; D014057:Tomography, X-Ray Computed