A case report of pyothorax caused by the swallowing of a press-through package

Abstract

We report a case of pyothorax caused by the swallowing of a press-through package (PTP) by mistake. A 79-year-old man developed fever and epigastralgia. He was examined but no cause was found for the symptoms. Although antibiotic therapy was started, not only did his symptoms not improve but he developed dyspnea and subcutaneous emphysema. At this point, the patient was admitted to hospital. The chest CT showed a left pyothorax and mediastinal emphysema. After chest drainage, esophageal endoscopy was done to identify the cause of the pyothorax ; esophageal injury was suspected given the presence of mediastinal emphysema. A PTP was found in the thoracic esophagus 35 cm distal to the dentition ; an ulcer was present. An esophageal perforation caused the PTP injury was likely the cause of the pyothorax. The PTP was endoscopically removed. The pyothorax and esophageal perforation could be successfully treated by thoracic drainage and lavage. The diagnosis of esophageal injury caused by PTP is difficult to make if the patient does not report swallowing a PTP. PTP swallowing should be considered in patients with fever and epigastralgia because delay of the diagnosis and therefore of treatment might result in serious complications.