Rare case of fishbone-penetrated heart causing Staphylococcus aureus infection in a 51-year-old man

China: A recent case study published in European Heart Journal describes a rare case where a swallowed fishbone which was nearly an inch long, pierced through the heart into the left atrium and resulted in a Staphylococcus aureus infection. 

A swallowed foreign body, such as a fishbone, usually passes through the oesophagus spontaneously without requiring therapeutic removal. 

The case in question is of a 51-year-old man hospitalized in a local hospital due to recurrent fever for 2 weeks. Staphylococcus aureus was found in the blood culture, but there was no clarity on the cause of the infection. The patient presented to The Affiliated Hospital of Southwest Medical University in Sichuan Province, China, for further treatment. 

Physical examination revealed that blood pressure and body temperature were normal. Transthoracic echocardiography showed abnormal echo in the left atrium, and CT (computed tomography) demonstrated a strip high-density shadow (foreign body) in the right lower pulmonary vein-- left atrium junction. 

Reviewing the history, Ruili Liao, Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, China, and colleagues suspected the patient of eating fishbone by mistake before the fever; however, gastroscopy showed no oesophageal injury, and aorta CT angiography indicated no damage to the thoracic aorta and post-mediastinum. The doctor's team could not determine that the foreign body was a fishbone. 

The patient underwent cardiac foreign body removal under extracorporeal circulation. During the operation, a 25 mm fishbone was found to have penetrated into the left atrium, and the fishbone's tip was free in the left atrium. The root of the fishbone was located in the muscle layer of the junction area between the right lower pulmonary vein and the left atrium, and the neoplasm was attached to the root of the fishbone

The operation was successful, and symptomatic treatment such as anti-infection was given afterwards. 

Reference:

Liao, R., Yang, Q., & Fu, Y. Rare cardiac foreign body: Fishbone-penetrated heart. European Heart Journal.https://doi.org/10.1093/eurheartj/ehad259