Presentation
Dysphagia and odynophagia after swallowing a fishbone.
Patient Data
Extensive pneumomediastinum from the neck to the diaphragm .
Large right hydropneumothorax with compressive atelectasis predominantly affecting the right middle and lower lobes.
Intercostal drain and nasogastric tube in situ.
Significant improvement of hydropneumothorax and pneumomediastinum.
Case Discussion
Esophageal perforation is an uncommon complication of eating fish but is potentially life-threatening. Perforation typically occurs where the esophagus is relatively narrow, such as the level of the aortic arch. The bone may migrate into the mediastinum causing polymicrobial anaerobic infection in the mediastinum and pleural cavity. Rare complications include tracheo-esophageal fistula and vascular injury.