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Image challenge
Man with worsening odynophagia
  1. Peng Yeh1,
  2. Wu-Chia Lo1,2,3,
  3. Chih-Ming Chang1,3,4
  1. 1 Department of Otolaryngology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
  2. 2 Graduate Institute of Medicine, Yuan Ze University, Taoyuan City, Taiwan
  3. 3 Department of Otolaryngology, National Taiwan University Hospital, Taipei City, Taiwan
  4. 4 Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei City, Taiwan
  1. Correspondence to Dr Chih-Ming Chang, Otolaryngology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; b88401077{at}ntu.edu.tw

https://doi.org/10.1136/emermed-2022-212650

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    Clinical introduction

    A 48-year-old man came to the emergency department (ED) due to a lump sensation in his throat after dinner. Neither obvious pharyngeal/laryngeal foreign body was seen with flexible nasopharyngoscopy nor apparent oesophageal abnormalities on the lateral neck radiograph (figure 1A). Due to persistent discomfort, he underwent oesophagogastroduodenoscopy without findings of upper gastrointestinal lesions. The patient returned to the ED with worsening odynophagia 5 days after the initial presentation. Another lateral neck radiograph was taken (figure 1B).

    Figure 1

    Lateral neck radiographs taken on (A) initial and (B) second ED visits.

    Question

    What is the most likely diagnosis?

    1. Migratory foreign body.

    2. Acute epiglottitis.

    3. Lingual tonsilloliths.

    4. Calcified parapharyngeal tumour.

    Answer

    A. Migratory foreign body.

    Initially, the …

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    Footnotes

    • Contributors PY and C-MC were major contributors in writing the manuscript and preparing the figures. PY, W-CL and C-MC were involved in the clinical management of the patient and gave the final approval of the submitted version. PY obtained consent from the patient. C-MC revised the manuscript and the figures.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.