The Foreign Body that Didn’t Exist

Except, of course, that it did…

A patient comes in with the entirely understandable complaint of “I have a fishbone lodged in my throat”. Came straight from dinner to the ED. When I ask a stupid question I’m given a stupid answer: “It feels like…a fishbone…”. Duh on me.

Now, I went to a pretty good EM residency, and while there I learned two things: the books say fishbones don’t show up on x-rays of the neck, and, fishbones sometimes show up on x-rays. I’m about 70% positive in my career…

So, I got an xray. See if you can spot the fishbone (hint: there’s an arrow pointing at it…)
photo.jpg

So, it’s there… Now what… There are very few wrong answers. Call ENT, etc. My answer: go get it.

With another doc giving the Propofol (I was going to say Milk of Michael, but the visual on that is just awful), pt asleep and relaxed, I did a direct laryngoscopy and pulled out a nice 2″ fishbone with the magill forceps. I bagged it for the patient, who was glad to have a souvenir (and probably a conversation starter with a restaurant manager). Patient awake and alert 5 minutes later, out before the x-ray reading came back.

“…no foreign body…” on the official x-ray interpretation. Sometimes it’s good not to have the reading immediately. Heh.


Comments

  1. well handled. i might have whipped out my trusty gastroscope without x-rays, however your approach is better for its position.

  2. I’m sure you have many of them too, but in this day of all these highly-trained radiologists, I remain a believer in looking at the images myself. I’m just grateful for the digital imaging and not having to go look at films anymore.

  3. Nice pick up!

    I’ve used nebulized lidocaine when removing pharyngeal foreign bodies. It works surprisingly often.

  4. Awesome pick up…I promise to look closer at my lateral neck x-rays in the future! And kudos for fixing it yourself!

  5. Nice “catch!”
    (I couldn’t help myself… )
    ;)

  6. Perhaps a silly question: If a 2 inch fishbone is successfully swallowed, will it cause problems fartehr down the gut, or tend to pass harmlessly?

  7. TheNewGuy says:

    Believe it or not, lots of sharp foreign bodies pass. I’ve even seen crazy stuff like glass and open (!) safety pins pass without incident.

    They don’t always pass… but lots of them do.

  8. Aerospace Genius says:

    Should you have gotten a fishing license before casting forceps in that lake?

  9. What kind of fish was it? Was it broiled, fried, poached, grilled, or blackened? C’mon…details are important! :-)

  10. whitecap nurse says:

    Addition to #12 – the likelihood of + pg. test is inversely proportional to the pt.’s fitness as a parent.

  11. What part of the body is that? I.e., what is the fishbone sitting on? And is that the trachea to the right?

  12. And as a corollary to WhiteCap’s theorum:

    “prognosis is inversely proportional to social worth.”

  13. “Fishbones often don’t show up on Xrays.”

    Is it because the fishbone is mostly cartilage?