An 87-year-old man presented with the sudden onset of dysphagia for solids and liquids of one-hour progression, with nausea and vomiting, and non-radiating central thoracic oppressive pain that increased upon swallowing. He presented with dysthermia, accompanied by dyspnea upon moderate effort and coughing. He stated he had no previous choking episodes. He was evaluated in the emergency department with the following test results: 12,900 leukocytes with a leftward slant; PO2: 52mmHg; pH: 7.40; and PCO2: 38mmHg measured through arterial gasometry. He was admitted to the Geriatrics Service with right basal pneumonia and acute hypoxemic respiratory failure.
The patient was functionally independent, with no cognitive deterioration or known mental disorders. He lived alone. His past medical history included a carotid transient ischemic attack and severe aortic stenosis with left ventricular hypertrophy diagnosed 3 months prior.
Upon his admission to the service, 24h from the onset of clinical symptoms, an emergency chest x-ray was taken, given the lack of symptom improvement after medical treatment. The lateral projection revealed a foreign body anterior to the ascending aorta (fig. 1), with no consolidation at the base of the right lung (fig. 2). Upper gastrointestinal endoscopy was performed that identified a bivalve shell in the mid-esophagus (fig. 3) with edematous and erythematous esophageal mucosa, and a small ulcer. The shell was extracted with a polypectomy basket, resolving the symptoms.
The authors declare that the procedures followed conformed to the ethical standards of the responsible committee on human experimentation and were in accordance with the World Medical Association and the Declaration of Helsinki.Data confidentiality
The authors declare that no patient data appear in this article.Right to privacy and informed consent
The authors declare that no patient data appear in this article.Financial disclosure
No financial support was received in relation to this study.Conflict of interest
The authors declare that there is no conflict of interest.
The authors wish to thank the Gastroenterologists that participated in the study.
Please cite this article as: López Pardo P, Jiménez Rojas C, Isach Comallonga M. Diagnóstico de neumonía en paciente anciano con concha de bivalvo en esófago medio. Revista de Gastroenterología de México. 2017. http://dx.doi.org/10.1016/j.rgmx.2016.12.001
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