Swallowing of a Foreign Body Leading to Misdiagnosis of ACS
Swallowing of a Foreign Body Leading to Misdiagnosis of ACS
Introduction Here we present our clinical experience in a case of esophagus perforation due to the swallowing of a bone piece causing acute angina pectoris and leading to misdiagnosis of acute coronary syndrome.
Case presentation A 73-year-old Caucasian man underwent urgent coronary angiography with possible diagnosis of acute coronary syndrome. His coronary arteries were found to be normal. A computed tomography examination revealed esophagus perforation by a foreign body (a piece of bone), and he underwent urgent left thoracotomy and the foreign body was removed.
Conclusions Sometimes, even a piece of bone within a meal can lead to esophagus perforation, and injure the pericardium and myocardium. The symptoms of esophagus perforation may be confused with acute coronary syndrome due to their similarities and lack of knowledge about the detailed clinical history as shown in our case. Thus, careful consideration of detailed clinical history as well as choosing an appropriate medical imaging modality, such as computed tomography, should always be kept in mind in order to promptly diagnose and start early treatment to reduce mortality.
Esophagus foreign bodies are mostly encountered in childhood. Although they are rarely seen in adults, the rate of mortality and morbidity is high in cases of perforation. Most esophagus perforations are iatrogenic. Perforations due to foreign bodies are rare, and complications are mostly encountered with sharp-edged objects. Foreign bodies in the esophagus should be removed immediately because of the risk of complications. A few cases of cardiac tamponade due to esophagus perforation have been reported, but the symptoms were not confused with acute coronary syndrome. Esophagus perforation should be kept in mind in patients referring with acute chest pain. Although clinical history and radiological evaluation are usually sufficient for the diagnosis, computed tomography (CT) is the most sensitive diagnostic modality. Patients may refer with shortness of breath and chest pain. Prompt diagnosis and early treatment are important in preventing high mortality and morbidity rate in cases of esophagus perforation. Early surgery should be the first treatment choice. Here we present our clinical experience in a case of esophagus perforation due to swallowing of a bone piece causing acute angina pectoris and leading to misdiagnosis of acute coronary syndrome.
Abstract and Introduction
Abstract
Introduction Here we present our clinical experience in a case of esophagus perforation due to the swallowing of a bone piece causing acute angina pectoris and leading to misdiagnosis of acute coronary syndrome.
Case presentation A 73-year-old Caucasian man underwent urgent coronary angiography with possible diagnosis of acute coronary syndrome. His coronary arteries were found to be normal. A computed tomography examination revealed esophagus perforation by a foreign body (a piece of bone), and he underwent urgent left thoracotomy and the foreign body was removed.
Conclusions Sometimes, even a piece of bone within a meal can lead to esophagus perforation, and injure the pericardium and myocardium. The symptoms of esophagus perforation may be confused with acute coronary syndrome due to their similarities and lack of knowledge about the detailed clinical history as shown in our case. Thus, careful consideration of detailed clinical history as well as choosing an appropriate medical imaging modality, such as computed tomography, should always be kept in mind in order to promptly diagnose and start early treatment to reduce mortality.
Introduction
Esophagus foreign bodies are mostly encountered in childhood. Although they are rarely seen in adults, the rate of mortality and morbidity is high in cases of perforation. Most esophagus perforations are iatrogenic. Perforations due to foreign bodies are rare, and complications are mostly encountered with sharp-edged objects. Foreign bodies in the esophagus should be removed immediately because of the risk of complications. A few cases of cardiac tamponade due to esophagus perforation have been reported, but the symptoms were not confused with acute coronary syndrome. Esophagus perforation should be kept in mind in patients referring with acute chest pain. Although clinical history and radiological evaluation are usually sufficient for the diagnosis, computed tomography (CT) is the most sensitive diagnostic modality. Patients may refer with shortness of breath and chest pain. Prompt diagnosis and early treatment are important in preventing high mortality and morbidity rate in cases of esophagus perforation. Early surgery should be the first treatment choice. Here we present our clinical experience in a case of esophagus perforation due to swallowing of a bone piece causing acute angina pectoris and leading to misdiagnosis of acute coronary syndrome.