It's a cod! Finding Nemo (impacted fishbone) in the emergency department

Abstract

A 23-year-old woman presented to the emergency department (ED) with a sensation of a 'fish bone' stuck in her throat after eating cod. On physical examination, while she reported an uncomfortable sensation in her throat, no airway compromise was evident. Clinical examination, including ear, nose and throat (ENT) and oropharyngeal assessment, was unremarkable. A linear opacity consistent with a fishbone was visualised on a soft tissue lateral neck X-ray anterior to the vertebral body of C4-6. One attempt to visualise the fishbone on direct laryngoscopy failed in the ED. The fishbone was later removed the next day via direct visualisation with a flexible endoscope in the operating theatre by the ENT surgical team. The patient's recovery was uneventful.

Carotid artery perforation by fish bone - a case report

“…When the foreign body cannot be directly visualized, complementary exams should be sought before the patient is released. 7,8 The use of cervical radiography to identify fish bones presents low sensitivity. 7,8 Tomography is the exam of choice due to the sensitivity > 90% for fishbone detection, in addition to displaying complications such as abscesses and vascular lesions and making it possible to analyze the shape, size, and location of the foreign body.…”

“…7,8 The use of cervical radiography to identify fish bones presents low sensitivity. 7,8 Tomography is the exam of choice due to the sensitivity > 90% for fishbone detection, in addition to displaying complications such as abscesses and vascular lesions and making it possible to analyze the shape, size, and location of the foreign body. 8,9 Symptoms such as odynophagia, dysphagia, or the sensation of a foreign body when swallowing cannot determine the exact location of the foreign body.…”

“…7,8 Tomography is the exam of choice due to the sensitivity > 90% for fishbone detection, in addition to displaying complications such as abscesses and vascular lesions and making it possible to analyze the shape, size, and location of the foreign body. 8,9 Symptoms such as odynophagia, dysphagia, or the sensation of a foreign body when swallowing cannot determine the exact location of the foreign body. Base of tongue, tonsils, posterior pharyngeal wall, aryepiglottic folds, and upper esophagus in locations of anatomical narrowing are, in decreasing order, the most frequent areas of fish bone impaction.…”

“…Base of tongue, tonsils, posterior pharyngeal wall, aryepiglottic folds, and upper esophagus in locations of anatomical narrowing are, in decreasing order, the most frequent areas of fish bone impaction. 8,10,11 Once a foreign body lodged in the cervical tissues is identified, it must be promptly removed, considering that the delay in removal leads to severe sequelae. 12 In this case, the surgeon must be able to perform an exploratory cervicotomy with delicate dissection of the cervical structures in search of the foreign body.…”

Lesão transfixante de carótida por espinha de peixe - relato de caso

“…Os pacientes que chegam ao setor de emergência com queixa de corpo estranho devem ser examinados com visualização direita da orofaringe com auxílio de um abaixador de língua. Quando o corpo estranho não for diretamente visualizado, deve ser procurado com exames complementares antes de o paciente ser liberado 7 , 8 .…”