Migrating fish bone presenting as acute onset of neck lump

Area of Science:

• Otolaryngology
• Surgical Pathology

Background:

• Foreign body ingestion is common, but migration into neck structures is rare.
• Fish bone impaction typically presents with throat pain or dysphagia.

Observation:

• A 62-year-old woman presented with acute neck lump and sore throat.
• Computed tomography revealed a foreign body penetrating the sternocleidomastoid muscle with emphysema.
• Initial esophagoscopy for suspected fish bone was negative.

Findings:

• A subcutaneous migrating fish bone was surgically removed from the neck.
• The patient experienced rapid onset of symptoms (1 day) with acute toxic signs.
• This contrasts with literature reporting weeks to months for lump development and stable conditions.

Implications:

• This case underscores the importance of advanced imaging in suspected foreign body ingestion with atypical symptoms.
• Rapidly migrating foreign bodies can present acutely, requiring prompt surgical intervention.
• Clinicians should consider foreign body migration in the differential diagnosis of acute neck masses.