Fish bone-induced myocardial injury leading to a misdiagnosis of acute myocardial infarction: A case report

Abstract

BACKGROUNDAcute chest pain (ACP) is very common among patients presenting to emergency departments. Nevertheless, ACP caused by esophageal foreign body is relatively rarely reported.CASE SUMMARYA 56-year-old man suffering from chest pain (increased pain for the last 9 h) was admitted to our hospital on October 25, 2015. After undergoing physical examination and laboratory blood testing, he was diagnosed with acute anterior myocardial infarction. Consequently, the patient underwent emergency percutaneous coronary angiography; however, no myocardial infarction signs were observed. Later on, the patient experienced respiration failure and therefore was transferred to intensive care unit. Cardiac ultrasound showed pericardial effusion, which was considered as the cause of shock. He then underwent pericardium puncture drainage and the circulation temporarily improved. Nevertheless, persistent pericardial bleeding, unclear bleeding causes, and clot formation induced poor drainage led to worsening of cardiac tamponade symptoms. Consequently, the patient underwent emergency exploratory thoracotomy, which revealed a fish bone causing pericardial bleeding. The bone was removed, and the damaged blood vessels were mended. Eventually, the patient was discharged in good clinical condition.CONCLUSIONFor patients with chest pain, it is necessary to consider the possibility of foreign body in the esophagus or even in the heart. Careful history taking and the corresponding inspection can help to avoid unnecessary damage and safeguard patients from unnecessary pain.

Esophageal Perforation by Fish Bone Ingestion Causing Purulent Pericarditis

“…It may also assist the evaluation of complications related to this condition, such as perforation of attached structures, abscesses, mediastinitis, and aortic fistulas. 1,[5][6][7][8] We used a multidisciplinary consultative approach to evaluate the patient's clinical presentation and reached a consensus for an emergency exploratory left lateral thoracotomy to be performed. Such early intervention is strongly recommended by other reports of such critical injuries.…”

“…Because it is a rare condition, esophageal perforations by foreign bodies may not be appreciated initially, and this may, of course, lead to an incorrect diagnosis and management. 5 Of paramount importance, primary evaluation of sudden-onset dysphagia with any other symptoms should include obtaining the patient's history in depth, physical and biochemical examination, and be accompanied by early imaging tests that include radiography and computed tomography (CT) scan.…”

“…It may also assist the evaluation of complications related to this condition, such as perforation of attached structures, abscesses, mediastinitis, and aortic fistulas. 1 , 5 – 8 …”

Pulmonary artery penetration due to fish bone ingestion: A rare case report

“…In rare cases, fish bones may migrate to the cervical cavities and adjacent thyroid structures [10] . Several locations of vascular injury due to fish bones have been reported including the aorta, subclavian artery, common carotid artery, and superior vena cava [ 5 , [14] , [15] , [16] ]. The presentation of the foreign body inside vessels is believed to relate to 2 main mechanisms: the foreign body directly penetrates the vessel wall and the inflammatory process causes erosion of the adjacent vessel wall.…”

Dynamic monitoring of a migrating and penetrating intracardiac foreign body by echocardiography perioperatively

“…Foreign bodies with sharp nature have a tendency to migrate though tissues and lead to serious complications. Wang et al reported a case that a swallowed fish bone resulting in cardiac injury and devastating tamponade 5 . In the present case, there was a risk that the needle might penetrate the diaphragm into the abdominal cavity, which would probably cause abdominal organ damage and bleeding.…”