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When Clinical Suspicion Trumps Radiology


A patient comes in with the entirely understandable complaint of “I have a fishbone lodged in my throat”. Came straight from dinner to the ED. When I ask a stupid question I’m given a stupid answer: “It feels like…a fishbone…”. Duh on me.

Now, I went to a pretty good EM residency, and while there I learned two things: the books say fishbones don’t show up on x-rays of the neck, and, fishbones sometimes show up on x-rays. I’m about 70% positive in my career…

So, I got an xray. See if you can spot the fishbone (hint: there’s an arrow pointing at it…)

So, it’s there… Now what… There are very few wrong answers. Call ENT, etc. My answer: go get it.

With another doc giving the Propofol (I was going to say Milk of Michael, but the visual on that is just awful), pt asleep and relaxed, I did a direct laryngoscopy and pulled out a nice 2″ fishbone with the magill forceps. I bagged it for the patient, who was glad to have a souvenir (and probably a conversation starter with a restaurant manager). Patient awake and alert 5 minutes later, out before the x-ray reading came back.

“…no foreign body…” on the official x-ray interpretation. Sometimes it’s good not to have the reading immediately. Heh.

*This blog post was originally published at GruntDoc*

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