Hidden Threat: Delayed Diagnosis of Fish Bone Migration Causing Aortic Pseudoaneurysm

Fish bone ingestion is a common presentation to the emergency department, usually benign and self-limiting. But in rare instances, migration of a sharp foreign body beyond the oesophageal wall can lead to life-threatening complications such as mediastinitis, vascular injury, or pseudoaneurysm formation. We present a case of a 66-year old man who presented with recurrent complaint of chest pain that was initially diagnosed as pneumonia and low-risk chest pain. Further history revealed fish bone ingestion approximately a month earlier, coinciding with the onset of his symptoms. A computed tomography angiography (CTA) of the aorta confirmed a thoracic aortic pseudoaneurysm with an embedded fish bone. During admission, the patient developed massive haemoptysis and, despite resuscitation efforts, passed away. This case highlights the importance of maintaining a high index of suspicion for atypical aetiologies in patients with persistent or unexplained symptoms. A thorough history taking and appropriate imaging are vital in identifying rare but fatal complications.