A Fish Bone Penetrating the Esophagus Into the Left Atrium.

BACKGROUND

Fish bone migration into the left atrium is extremely rare and carries high mortality.

CASE SUMMARY: A 68-year-old woman presented with chest pain, fever, and dyspnea 5 days after swallowing a fish bone; she had attempted to dislodge it with a rice ball. Contrast-enhanced computed tomography showed a 2.9-cm linear foreign body penetrating the mid-esophagus into the left atrium. Transthoracic echocardiography revealed a 2.3-cm echogenic mass in the left atrium without pericardial effusion. Emergency surgery under cardiopulmonary bypass extracted the fish bone, debrided a large vegetation and abscess, repaired the atrial wall, and drained the esophageal perforation. She recovered uneventfully and was discharged on day 12. At 1-month follow-up, cardiac function was normal, and no complications occurred.

CONCLUSION

This case illustrates the "pump-saw" mechanism and the diagnostic value of computed tomography. Successful management requires multidisciplinary teamwork, standby extracorporeal circulation, and prolonged antibiotics.