THYROHYOID LIGAMENT CALCIFICATION MIMICKING FOREIGN BODY ESOPHAGUS; A RARE CASE REPORT AND REVIEW OF THE LITERATURE

Abstract

 Background: Foreign body ingestion frequently occurs in the extreme of ages. Meat bolus, fishbone buried in the food, and sharp bone are the common ingested foreign bodies among adults. The normal ligament and bony structure start to ossify after the third decade of life and mimic foreign bodies. Ossified thyrohyoid ligament, cricothyroid ligament, cornu of hyoid bone may be misdiagnosed as a foreign body in the aerodigestive tract.

Case presentation: We describe a 54 years female who presented with painful swallowing for two days after eating chicken bone at Emergency Department. X-ray soft tissue neck lateral view showed a radiopaque shadow in front of the C3-C4 region. The patient underwent rigid esophagoscopy, however, a foreign body could not be found at the pharynx. Computerized Tomography (CT) shows the same hyperdense shadow at the same location as seen in the x-ray. Furthermore, Magnetic resonance imaging (MRI) scan was done to localize the exact site of the foreign body, but the patient was a case of thyrohyoid calcification rather than foreign body in the esophagus.

Conclusion: Difficulty arises for the surgeons when a foreign body is not found during rigid esophagoscopy. It is important to reassess and locate the foreign body by imaging. The calcified ligament can mimic a foreign body in the neck. MRI confirms the diagnosis which may be misguided by X-ray and CT-scan.