Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2019; 7(20): 3335-3340
Published online Oct 26, 2019. doi: 10.12998/wjcc.v7.i20.3335
Fish bone-induced myocardial injury leading to a misdiagnosis of acute myocardial infarction: A case report
Qian-Qian Wang, Yi Hu, Liang-Feng Zhu, Wen-Jun Zhu, Peng Shen
Qian-Qian Wang, Peng Shen, Department of Intensive Care Unit, The First Hospital of Jiaxing, Jiaxing 314001, Zhejiang Province, China
Yi Hu, Department of Cardiac Surgery, The First Hospital of Jiaxing, Jiaxing 314001, Zhejiang Province, China
Liang-Feng Zhu, Department of Cardiology, The First Hospital of Jiaxing, Jiaxing 314001, Zhejiang Province, China
Wen-Jun Zhu, Department of Ultrasound, The First Hospital of Jiaxing, Jiaxing 314001, Zhejiang Province, China
Author contributions: Wang QQ and Shen P were the patient’s intensive care physicians, and they reviewed the literature and contributed to manuscript drafting; Hu Y was the patient’s cardiothoracic surgeon, and he reviewed the literature and contributed to manuscript drafting; Zhu LF contributed to manuscript drafting; Zhu WJ analyzed and interpreted the imaging findings. All authors approved the publication of the manuscript.
Supported by The Key Medical Disciplines of Jiaxing - Critical Care Med (Supporting Subject), No. 2019-zc-12.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Peng Shen, PhD, Chairman, Department of Intensive Care Unit, The First Hospital of Jiaxing, 1882 Zhonghuannan Road, Jiaxing 314001, Zhejiang Province, China. docshen@126.com.
Telephone: +86-573-82519928
Received: June 15, 2019
Peer-review started: June 19, 2019
First decision: September 9, 2019
Revised: September 21, 2019
Accepted: September 25, 2019
Article in press: September 25, 2019
Published online: October 26, 2019
Processing time: 134 Days and 16.4 Hours
Abstract
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.

Keywords: Chest pain; Acute myocardial infarction; Pericardial effusion; Fish bone; Case report

Core tip: Chest pain is a symptom causing more attention by clinicians, and the common reasons include acute coronary events, aortic dissection, pulmonary embolism and so on, while that caused by esophageal foreign body is relatively rare. We present herein, a rare case of acute chest pain as the chief complaint that was diagnosed as acute myocardial infarction initially, then developed cardiac tamponade and severe shock, and was finally diagnosed as fish bone-induced myocardial injury by surgery. This case highlights the possibility of foreign body in the esophagus or even in the heart for patients with acute chest pain.