1749 Hematoma Involving the Inter-Arytenoid Fold: A Rare Mimic of Esophageal Foreign Body Impaction

Abstract

INTRODUCTION: Approximately 120,000 cases of foreign body ingestion are reported annually in the United States. Although over 80% of ingested objects will pass spontaneously, approximately 10-20% may need endoscopic intervention and removal. Among US adults, food impaction is the most common cause of esophageal foreign body impaction. Typical presenting features include chest discomfort, inability to swallow food or secretions, foreign body sensation, and painful swallowing. This report details a rare cause for esophageal foreign body sensation raising suspicion for an impacted foreign body. CASE DESCRIPTION/METHODS: A 75 year old man presented to the emergency room with history of a sensation of something stuck in his throat. He had eaten a normal meal consisting of chicken before onset of symptoms. Abut 2 hours later, he became violently ill with stomach pain and dry heaves resulting in forceful vomiting, following which he developed a foreign body sensation in the throat. He was concerned that a piece of chicken was stuck in the upper esophagus or throat. He was able to swallow water and secretions, but reported pain on swallowing. He was not on any anticoagulant or antiplatelet agents. A trial of intravenous glucagon did not alleviate his pain, but viscous lidocaine resulted in temporary relief in his sensation. Given the history and reported foreign body sensation, he was scheduled for an endoscopy with conscious sedation. Endoscopy showed a hematoma involving the inter-arytenoid fold in the throat, with slight impingement of the tracheal opening. The esophagus was easily intubated alongside the hematoma, and appeared slightly tortuous but otherwise normal. Given lack of additional findings, it was felt that the hematoma was the cause for his foreign body sensation. Given slight impingement of the tracheal opening, an ENT consultation was obtained. The patient was conservatively managed as outpatient and reported improvement in symptoms within three days of hospital discharge. DISCUSSION: Inter-arytenoid hematoma is a rare entity. A review of literature showed only one previous report of symptomatic inter-arytenoid hematoma. This case is unique in that the cause for hematoma formation was forceful vomiting in the absence of any anticoagulant or antiplatelet use. In patients who present with suspected foreign body impaction, alternate causes for symptoms should be considered.