An 87 year old presented with increasing throat pain 7 hours after choking on a fish bone.
The X-Ray was reported as normal by the junior doctor on over-night. The patient was kept in for symptomatic relief.
Next day the X-Ray was reported by the radiologist and the retropharyngeal gas was noted. No fish bone was seen. (The patient also has pretty spectacular osteophytes which can be distracting)
The presumed puncture into the retropharyngeal space can lead to an airway threatening retropharyngeal abscess. It shouldn’t cause a mediastinitis as the retropharyngeal space goes down to T4-5 and is not contiguous with the mediastinum.
The patient was transferred to a hospital with ENT cover for nil by mouth, pharyngoscopy, oesophogoscopy (to look for foerign bodies), IV antibiotics and observation.