Rare case of fish bone migration: thrombophlebitis of the internal jugular vein

Abstract

A 52-year-old female was referred with increasing right-sided neck pain and odynophagia, on a background of presentation 3 days prior, to a regional hospital with similar symptoms following the consumption of fish. At the time of initial review, a lateral neck Xray was performed and a 21.6-mm foreign body was seen at the level of C6/C7 posterior to the cricoid cartilage. No associated soft tissue swelling or gas was seen (Fig. 1). She was admitted under general surgery and underwent gastroscopy with no foreign body found. She was discharged that evening. Ultrasound and computed tomography (CT) of her neck were performed given the progression of symptoms. The CT demonstrated a fish bone, perforating through the upper oesophagus between the right lobe of the thyroid and the common carotid, with the tip situated within the right internal jugular vein. The resultant thrombus had occurred measuring 60 mm in length from the level of the carotid bifurcation to 20 mm above the commencement of the brachiocephalic vein (Figs 2–3). Prompt initiation of broad spectrum intravenous antibiotics was conducted post recognition of migrating fish bone. Open surgical removal was performed to prevent further localized trauma and lifethreatening Lemierre’s syndrome. The oesophagus was mobilized and no leak or collections were found. The bone was located anteromedially to the partially thrombosed internal jugular vein which