Unusual presentation of more common disease/injury
Indolent form of mediastinitis caused by oesophageal perforation from fish bone ingestion
1 Heart Institute, Thoracic Surgery Department, Av Dr Eneas Carvalho de Aguiar, 44, São Paulo, 05406000, Brazil
2 Hospital Sírio-Libanês, Thoracic Surgery Department, Rua Dona Adma Jafet 91, São Paulo, 05406-000, Brazil
3 Hospital Sírio-Libanês, Emergency Department, Rua Dona Adma Jafet 91, São Paulo, 05406-000, Brazil
4 Hospital Sírio-Libanês, Radiology Department, Rua Dona Adma Jafet 91, São Paulo, 05406-000, Brazil
Correspondence to:
Alessandro W Mariani, alessandro_mariani{at}hotmail.com
Mediastinitis caused by oesophageal perforation usually presents as a severe disease that can quickly progress to sepsis and death. We report a case with an indolent form of mediastinitis, caused by fish bone ingestion, which was successfully and exclusively treated with antibiotics. The patient had only one symptom, intense thoracic pain, with no signs of infection except for elevated C reactive protein. The diagnosis was difficult to obtain because of this atypical clinical presentation. The chest computed tomography scan combined with the thoracic pain and the history of fish bone ingestion allowed us to confirm the diagnosis and initiate treatment.
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