Vol 29, No 3 (2022)
Image in Cardiovascular Medicine
Published online: 2022-05-31

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Fish bone or calcification of arterial ligament?

Meng Zhao1, Jingxin Zhou1, Yihu Tang1, Xiang Liu1, Yanhu Wu1
Pubmed: 35652140
Cardiol J 2022;29(3):523-524.


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Cardiology Journal 2022, Vol. 29, No. 3, 523–524

DOI: 10.5603/CJ.2022.0040 Copyright © 2022 Via Medica

ISSN 1897–5593 eISSN 1898018X

Fish bone or calcification of arterial ligament?

Meng ZhaoJingxin ZhouYihu TangXiang LiuYanhu Wu
Department of Cardiovascular Surgery, Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China

Address for correspondence: Dr. Xiang Liu, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China, 210029, tel: +86 13770912266, fax: +86 25 83724440, e-mail: 13770912266@139.com; Dr. Yanhu Wu, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China, 210029, tel: +86 13951945999, fax: +86 25 83724440, e-mail: wuyanhu@njmu.edu.cn

Received: 5.04.2021 Accepted: 3.07.2021

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

A 34-year-old woman was admitted to the documented hospital for backache. She had swallowed a fishbone 3 days prior, and nothing could be found by gastroscopy in a local hospital. After admission, a computed tomography (CT) was performed, a high-density shadow could be seen beneath the arcus aortae (Fig. 1A). The “fishbone” was so close to the aorta and pulmonary artery that an emergency operation was performed to prevent the possibility of rupture.

After surgery, the patient felt the backache disappear. Before discharge, a CT was performed again and the high-density shadow had disappeared when compared with the previous picture (Fig. 1B). Five days later, a pathological examination showed calcification of cartilage. But, strangely, as a foreign body, inflammatory cells could not be found around the “fishbone” (Fig. 1C). Considering the position and pathological result of the “fishbone”, another possibility came to mind: calcification of arterial ligament (CAL). For further conformation, a blood sample and pathological section was sent to the Academy of Forensic Science for DNA sequencing after acquiring permission from the patient. 16 loci (D3S1358, D1S1656, D6S1043, D13S317, D16S539, D18S51, D2S1338, TH01, vWA, D7S820, D5S818, TP0X, D8S1179, D12S391, D19S433, Amelogenin) were exactly the same in 2 samples and 5 loci (Penta E, CSF1P0, Penta D, D21S11, and FGA) could not be detected in the pathological section (Suppl. Fig. 1)

Figure 1. A. A high-density shadow could be seen before surgery; B. The high-density shadow disappeared after surgery; C. Pathology showed calcification of cartilage.


In conclusion, an eye should be kept on CAL when handling an emergency esophageal foreign body based on the lesson learned from this case.


This work was financially supported by projects of the National Scientific Foundation of China (NSFC, Grant Nos. 81700340).

Conflict of interest: None declared