Mediastinal abscess revealed by computed tomography after pharyngeal fish-bone impaction

Area of Science:

• Otolaryngology
• Gastroenterology
• Infectious Diseases

Background:

• Fishbone impactions in the upper aerodigestive tract are common but typically have good outcomes with prompt treatment.
• Delayed recognition of foreign body ingestion can lead to significant morbidity.

Observation:

• A 52-year-old male presented with symptoms 2 weeks after a suspected fishbone impaction.
• Clinical presentation included fever, odynophagia (painful swallowing), and a toxic appearance.
• Computed tomography (CT) scan identified a large cervicomediastinal abscess.

Findings:

• The patient received broad-spectrum antibiotics and underwent surgical drainage for the abscess.
• The cervicomediastinal abscess, a severe complication of fishbone impaction, was successfully treated.
• The patient experienced an uneventful recovery.

Implications:

• This case underscores the potential for severe complications from seemingly minor upper digestive tract fishbone impactions.
• Preoperative CT scanning is invaluable for diagnosing deep-seated abscesses and guiding surgical management.
• Highlights the importance of timely medical evaluation for suspected foreign body ingestion to prevent serious sequelae.