An unusual cause of dysphagia: Esophageal external compressive stricture caused by abscess.

A 66-year-old previously healthy woman presented with mild dysphagia for the past 1 week. She denied fever, chest pain, weight loss, and history of gastrointestinal carcinoma and previous surgery. Physical examination was unremarkable with no lymphadenopathy. A computed tomography (CT) scan showed a large and soft tissue density mass in the upper esophagus (Fig. 1A). She underwent upper gastrointestinal endoscopy which revealed a bulging mass with normal looking mucosa in the upper esophageal region at 18 cm from the incisor (Fig. 1B). Endoscopic ultrasound examination confirmed the lesion was about 3.0 cm in diameter and was located outside the esophagus with no recognizable echo patterns (Fig. 1C). An extra esophageal cyst was initially suspected. Endoscopic ultrasound-guided cyst drainage was performed and approximately 10 mL of yellow-brown purulent exudate was aspirated (Fig. 1D). Laboratory tests of the so-called cyst revealed severe neutrophilic leukocytosis (48,469/m3 white blood cells and 16,964/m3 neutrophils), which were entirely consistent with important components of abscess. Further questioning of the patient found that, 3 months ago, she swallowed a fish bone by mistake with no endoscopic intervention. Extraesophageal migration of an ingested fish bone leading to localized abscess is a rare condition.