A 66-year-old woman presented to the emergency department with sudden-onset, severe thoracic back pain associated with dyspnoea and diaphoresis after consuming lunch. She was otherwise well, and her only medical history of note was gastro-oesophageal reflux disease.
A computed tomography scan showed a 2.7 cm transverse, linear foreign body in the patient’s oesophagus at the level of the aortic arch (Figure, arrow). This had caused perforation, pneumothorax, pneumomediastinum and pneumopericardium.
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