Abstract
A thyroid abscess is a rare condition, and it is so infrequently encountered. A migrated fish bone is a rare otolaryngologic emergency indicated when the foreign body penetrates through the esophageal mucosa into the thyroid gland space of the neck after several weeks of swallowing. We present the case of a 50-year-old woman who had fever and anterior neck painful mass. An intrathyroid abscess was diagnosed; and she underwent thyrotomy with transcervical approach. A foreign body, which proved to be a fish bone and which fortunately did not cause any adverse effects, was removed.
1
Introduction
Thyroid abscess is infrequent in adults. Thyroid abscess caused by direct trauma from an ingested fish bone is extremely rare . In adults, most penetrating foreign bodies are fish bones or sharp materials that are unexpectedly ingested during eating. The most common site of penetration is the cervical esophagus, followed by the upper thoracic esophagus. It is important that if fish bones are not found or missed by oral examination and a flexible endoscopic examination, then this should not exclude their presentation. The diagnosis of extraluminal foreign bodies is facilitated by a high index of suspicion. Early computed tomographic (CT) scan of the neck or a rigid esophagoscopic examination should be carried out to provide prompt and appropriate management and to avoid any following life-threatening consequences.
2
Case report
A 50-year-old woman presented to the emergency department with increasing painful and enlarged mass in the anterior neck 1 month after eating an unknown species of fish. She had visited an otolaryngologist; but no fish bone was found after thorough examination, including flexible fiberoptic pharyngolaryngoscopy. Laboratory data were as follows: white blood cells, 12 800/mm 3 and C-reactive protein, 15.04 mg/dL. She had been given intravenous cefazolin for 5 days without clinical improvement. A lateral film of the neck revealed linear opacity over the middle esophagus ( Fig. 1 ). Neck CT image demonstrated a thin radiopaque linear foreign body traversing the esophagus and penetrating into the thyroid gland. Also seen was a thyroid abscess ( Fig. 2 ). Under the impression of a buried fish bone complicating as thyroid abscess, an emergent rigid esophagoscopy was performed under general anesthesia. Despite a thorough search, the fish bone could not be found. We made a horizontal incision in the anterior neck because of the shorter distance to the fish bone. However, the thin buried fish bone was very difficult to identify from the surrounding inflamed thyroid gland. Exploratory thyrotomy confirmed that a fish bone ( Fig. 3 ) had perforated the esophagus and migrated into the thyroid gland. The neck exploration revealed a fish bone embedding at the right thyroid gland and near recurrent nerve triangle. The fish bone was removed. Culture grew multiple organisms, including α -hemolytic streptococcus, group A streptococcus, group D streptococcus, Klebsiella species, and Veillonella species. Her antibiotic regimen was changed to ampicillin and gentamicin. Her recovery was uneventful.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
