Dysphagia after fish consumption – the typical case?

We report on a 71-year-old female patient who presented with a progressive, piercing foreign body sensation a few hours after fish consumption in November 2020. After a clinically unremarkable ENT examination, endoscopy was performed under general anesthesia. Here, no foreign body could be detected either. However, a small patch of granulation tissue was noted on the anterior wall of the right piriform sinus. Histopathological examination of a biopsy taken here revealed only reactive epithelial changes. The patient could be discharged from the inpatient stay with already regressive symptoms. 5 days later, the patient was presented again from a peripheral hospital with fever, general fatigue, and progressive odynophagia. Examination continued to show no foreign body and only a minor case of cervical lymphadenopathy. The patient was admitted to the hospital for i.v.-antibiotic therapy. Due to the lack of improvement and clinical hints on a thyroiditis, the patient received several radiological examinations and was presented for a nuclear medicine co-evaluation. The combined findings of sonography, CT-scan and a MRI led to the suspicion of a foreign body in the right lobe of the thyroid gland, presumably the fish bone beeing the cause of the inflammation. After failed attempts at ultrasound-guided or endoscopic removal of the fishbone, the patient finally received a hemithyroidectomy. Intraoperatively, the fishbone could be salvaged. The patient recovered completely.

Publication History

Article published online:
12 May 2023