Fish bone-induced myocardial injury leading to a misdiagnosis of acute myocardial infarction: A case report

Background: Acute chest pain (ACP) is very common among patients presenting to emergency departments. Nevertheless, ACP caused by esophageal foreign body is relatively rarely reported.

Case summary: A 56-year-old man suffering from chest pain (increased pain for the last 9 h) was admitted to our hospital on October 25, 2015. After undergoing physical examination and laboratory blood testing, he was diagnosed with acute anterior myocardial infarction. Consequently, the patient underwent emergency percutaneous coronary angiography; however, no myocardial infarction signs were observed. Later on, the patient experienced respiration failure and therefore was transferred to intensive care unit. Cardiac ultrasound showed pericardial effusion, which was considered as the cause of shock. He then underwent pericardium puncture drainage and the circulation temporarily improved. Nevertheless, persistent pericardial bleeding, unclear bleeding causes, and clot formation induced poor drainage led to worsening of cardiac tamponade symptoms. Consequently, the patient underwent emergency exploratory thoracotomy, which revealed a fish bone causing pericardial bleeding. The bone was removed, and the damaged blood vessels were mended. Eventually, the patient was discharged in good clinical condition.

Conclusion: For patients with chest pain, it is necessary to consider the possibility of foreign body in the esophagus or even in the heart. Careful history taking and the corresponding inspection can help to avoid unnecessary damage and safeguard patients from unnecessary pain.