1. Case Conference Intern 曾順承

2. Patient Profile Chart No.: 23584715 Chart No.: 23584715 Name: 林 x 麗 Name: 林 x 麗 Gender: female Gender: female Age: 49 Age: 49 Date of visiting: May 16, 2007 Date of visiting: May 16, 2007

3. Chief Complaint Foreign body over left neck Foreign body over left neck

4. Present Illness This 49-year-old female denied any systemic disease. This 49-year-old female denied any systemic disease. She had had sore throat after swallowing a fishbone since April 27, 2007 She had had sore throat after swallowing a fishbone since April 27, 2007 She had visited our ER on April 27, and a fishbone stuck in the pharynx was noticed. She had visited our ER on April 27, and a fishbone stuck in the pharynx was noticed. On May 16, a foreign body over left neck was noticed, and then she went to ER for help. On May 16, a foreign body over left neck was noticed, and then she went to ER for help.

5. Physical Examination 1 Consciousness: clear Consciousness: clear Head: Head: Conjunctiva: not pale Conjunctiva: not pale Sclerae: n.p. Sclerae: n.p. Oral mucosa: n.p. Oral mucosa: n.p. Throat: congested Throat: congested

6. Physical Examination 2 Neck: a fishbone like foreign body penetrating skin over left neck Neck: a fishbone like foreign body penetrating skin over left neck

7. Physical Examination 3 Chest: Chest: H.S.: regular heart beat H.S.: regular heart beat B.S.: no adventitious sound B.S.: no adventitious sound Abdomen: n.p. Abdomen: n.p. Extremities: n.p. Extremities: n.p.

8. Image 1 04/24 (X-ray) 04/24 (X-ray)

9. Image 2 5/16 (CT) 5/16 (CT)

10. Treatment Consult ENT to remove it Consult ENT to remove it Under Laryngealscope: Under Laryngealscope:

11. Diagnostic Imaging 1 Thyroid cartilage calcifications Thyroid cartilage calcifications

12. Diagnostic Imaging 2 cartilage calcifications Cricoid cartilage calcifications

13. Diagnostic Imaging 3 cartilage calcifications Arytenoid cartilage calcifications

14. Diagnostic Imaging 4 Styloid processes and ligament calcifications Styloid processes and ligament calcifications

15. Diagnostic Imaging 5 Osteophytes Osteophytes

16. Similar Case Reports 1 Case 1: Case 1: A 71-year-old man had a migrated fish bone A 71-year-old man had a migrated fish bone

17. Similar Case Reports 2 Case 2: Case 2: A 66 year old woman had an ingested fish bone migrating into the common hepatic duct, without perforation. A 66 year old woman had an ingested fish bone migrating into the common hepatic duct, without perforation.

18. Similar Case Reports 3 Case 3: Case 3: A 61-year-old woman had a migratory fish bone in the thyroid gland A 61-year-old woman had a migratory fish bone in the thyroid gland

19. Similar Case Reports 4 Case 4: Case 4: A 2-year and 6-month-old boy had 2 fishbones that perforated than ileum loop and were discovered as foreign bodies surrounded by omentum in the inguinal canal A 2-year and 6-month-old boy had 2 fishbones that perforated than ileum loop and were discovered as foreign bodies surrounded by omentum in the inguinal canal Case 5: Case 5: A 13-year-old girl had a migratory fishbone which was found in the omentum during a laparotomy for suspected acute appendicitis. A 13-year-old girl had a migratory fishbone which was found in the omentum during a laparotomy for suspected acute appendicitis.

20. Thank you for attention!