Esophageal Foreign Body Which Caused Dyspnea Due to Cervical and Mediastinal Hemorrage.

An 81-year-old man visited our hospital because of pharyngeal discomfort after eating fish the previous day. Physical examination revealed only a slightly enlarged lymph node with tenderness on the left side of the neck. Laboratory findings showed leukocytosis but other tests were normal and the initial chest roentgenogram was also normal. During intravenous fluid administration in the emergency room, he suddenly developed severe dyspnea and the neck became swollen. After intubation the chest roentgenogram showed a widened mediastinum, and a computerized tomography scan revealed a bony density penetrating the esophagus and fluid collection in the posterior mediastinum from the level of the neck to the diaphragm. Under general anesthesia, the patient underwent rigid esophagoscopy and two fishbones were removed. A giant hematoma was detected in the posterior mediastinum and was surgically evacuated through a neck incision. He was discharged on the 17th postoperative day after an uneventful course.