Fishbone-induced Pericardial Hemorrhage Resulting in a Misdiagnosis of Acute Myocardial Infarction.

Fishbone intake is a common clinical event; but serious complications resulting from the ingestion of fishbones, such as perforations in the stomach, diaphragm, and pericardium and heart lacerations, are rare. Here, we present a case of fishbone-induced pericardial hemorrhage that led to a misdiagnosis of acute myocardial infarction (AMI) since the emergency coronary angiogram showed normal coronaries. However, the patient's circulatory status was not good and an echocardiogram revealed pericardial effusion. A contrast-enhanced computed tomography (CT) of the chest and abdomen showed a foreign body in the upper abdomen. Therefore, an urgent exploratory thoracotomy was performed, and it was discovered that the pericardial hemorrhage was caused by the fishbone puncturing the pericardium and myocardium of the right ventricle. The fishbone was removed, damaged vessels were repaired, and the pericardium was closed with a drain. The patient was discharged in good clinical condition. In order to avoid unnecessary damage and suffering, the possibility of a foreign body in the esophagus or heart must be considered when patients have chest pain, and careful reporting of histories and corresponding examinations are necessary.    Key Words: Acute myocardial infarction, Fishbone, Pericardial effusion.