Migrating fishbone embedded in the prevertebral soft tissue

Case contributed by Dr Ruwaida Bt Yaakub

Presentation

Fishbone stuck in throat for 4 days. Associated with fever. 70 degree scope showed pooling of saliva in the oropharynx, no foreign body seen.

Patient Data

Age: 75 years
Gender: Male

An elongated structure with sharp end consistent with a fish bone seen projects anterior to C5-C6 level.  Associated prevertebral soft tissue thickening from C4 to C6 level.

An elongated hyperdense structure which represents a fishbone is seen in the right prevertebral space, from the level of C5 to C6. There is extensive thickening of the prevertebral soft tissue from the level of C4 to C7 due to inflammation. Ill-defined hypodensities seen within the inflamed soft tissue could represent a fluid collection.

Nasopharynx, oropharynx and laryngeal structures are normal.

Case Discussion

Fish bones are one of the most commonly ingested foreign bodies encountered in the upper aerodigestive tract region. Owing to its trivial size, smooth surface, and sharp ends, fish bones have a great propensity to migrate in the neck and adjoining structures. Long standing migrated fishbone can cause devastating complications like neck abscess and injuries to the adjacent structures.

A careful history and a detailed clinico-radiographic investigation is helpful to locate the bone and aided in successful removal.

Herein, we report a case of ingested fish bone, which migrated and embedded in the prevertebral soft tissue. Laryngoscopy and esophagoscopy were performed but the fishbone was not found. Based on the CT findings, neck exploration and removal of the fishbone was performed. During the exploration, the fishbone was at the right side of the posterior pharyngeal wall and embedded in the paraspinal muscle. Minimal pus was surrounding the fishbone.

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Case information

rID: 51389
Case created: 14th Feb 2017
Last edited: 14th Feb 2017
System: Head & Neck
Inclusion in quiz mode: Included

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