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BMJ Case Reports 2009; doi:10.1136/bcr.11.2008.1250
  • Unusual presentation of more common disease/injury

Indolent form of mediastinitis caused by oesophageal perforation from fish bone ingestion

  1. Alessandro W Mariani1,
  2. Paulo Manuel Pêgo-Fernandes2,
  3. Marcos Naoyoki Samano2,
  4. Euclides Furtado de Albuquerque Cavalcanti3,
  5. Juan José Cevasco4,
  6. Maurício Daniel Gattaz3
  1. 1
    Heart Institute, Thoracic Surgery Department, Av Dr Eneas Carvalho de Aguiar, 44, São Paulo, 05406000, Brazil
  2. 2
    Hospital Sírio-Libanês, Thoracic Surgery Department, Rua Dona Adma Jafet 91, São Paulo, 05406-000, Brazil
  3. 3
    Hospital Sírio-Libanês, Emergency Department, Rua Dona Adma Jafet 91, São Paulo, 05406-000, Brazil
  4. 4
    Hospital Sírio-Libanês, Radiology Department, Rua Dona Adma Jafet 91, São Paulo, 05406-000, Brazil
  1. Alessandro W Mariani, alessandro_mariani{at}hotmail.com
  • Published 4 June 2009

Summary

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.

Footnotes

  • Competing interests: none.

  • Patient consent: Patient/guardian consent was obtained for publication

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