Surgeons Miss CT-Visible Plastic Shard in Two Neck Surgeries Before Finding It by Touch

Repeated CT scans showed the same unusual finding: a thin, wire-like object roughly 30 millimeters long lodged deep in a 77-year-old woman’s neck, just in front of her spine. Despite that clear imaging clue, surgeons failed to locate it during two separate operations.

On the third attempt, doctors found the object by touch rather than sight. It was a rigid, transparent plastic shard with sharp, pointed edges, according to a case report published July 9 in the Journal of Personalized Medicine.

Doctors from the Department of Otorhinolaryngology, Head and Neck Surgery at Kepler University Hospital in Linz, Austria, said migrated plastic objects in the prevertebral space—the tissue area in front of the cervical spine—are extremely uncommon.

Swallowing Trouble Initially Linked to Blood Pressure Medication

The patient’s symptoms began after she took an ACE inhibitor, a widely used medication for high blood pressure. She reported difficulty swallowing and was seen at an outpatient clinic. Because ACE inhibitors can cause angioedema, a swelling reaction, doctors suspected that diagnosis and admitted her for steroid treatment.

Her test results did not fully support that explanation. The report’s authors noted that ACE inhibitor-related angioedema usually does not raise inflammatory markers or produce signs of widespread infection. In her case, those markers were elevated, prompting doctors to begin antibiotics.

Two days later, her condition worsened. Her circulation became unstable, and lab tests suggested multiple organ failure. She was transferred to intensive care, where doctors placed a breathing tube and gave medication to support her blood pressure.

A CT scan showed a left-sided prevertebral abscess—an infected pocket containing gas. After she stabilized, another scan revealed a 30-millimeter foreign object in front of her fifth cervical vertebra.

First Two Surgeries Fail to Locate the Object

Her medical history offered no obvious explanation. She did not remember swallowing anything unusual. An esophagogastroscopy, which uses a camera to examine the esophagus and stomach, found no tear or other injury, and no external wounds were visible on her neck.

She was transferred, still intubated, to Kepler University Hospital. Surgeons first approached the abscess through the mouth, making an incision on the left side of the lower throat to open and drain it. They removed pus and repeatedly rinsed the cavity, but they did not find the foreign body. They also did not use an X-ray during the procedure because the object had appeared faint on CT and was not expected to be easy to distinguish from nearby tissue.

Because her inflammatory markers remained high despite strong antibiotic treatment, surgeons performed a second operation, this time through an incision on the left side of her neck. A careful search by sight and by touch again failed to reveal the object.

The medical team considered whether the object could have been a bone fragment and continued antibiotics without further surgery. However, her inflammatory levels continued to fluctuate. Her C-reactive protein, a major marker of inflammation, rose to 24.4 mg/dL, compared with a normal range of 0 to 0.5 mg/dL. Additional CT scans continued to show a linear object in the prevertebral space, while a whole-body PET/CT scan found no other source of inflammation.

Fingers Find What Surgeons Could Not See

During a third operation through the neck, surgeons located the shard without imaging assistance by carefully feeling through the inflamed tissue. They removed it with forceps. The fragment measured about 30 by 5 millimeters and was between 1 and 2 millimeters thick.

Her recovery was swift. Inflammatory markers declined, her swallowing improved, and she was eventually discharged in better condition. The authors noted one limitation: no scheduled outpatient follow-up occurred, so they could not formally evaluate long-term recurrence or delayed complications.

How the plastic entered her neck remains unclear. The authors said accidental swallowing was the most plausible explanation, with the fragment piercing the throat or esophagus and migrating into the neck. They cautioned, however, that this theory remains speculative.

Why the Transparent Shard Was So Difficult to Detect

Fish bones are among the most commonly reported swallowed foreign objects, and many ingested items can be seen and removed during an exam or endoscopy, the authors wrote. The American College of Gastroenterology notes that doctors typically use upper endoscopy to retrieve lodged objects and that some materials, including bones, may not be visible on standard X-rays.

Objects that penetrate the lining of the throat or digestive tract can migrate, making diagnosis and treatment more difficult. The Austrian team cited a 2022 analysis of 20 cases involving migrating throat foreign bodies that emphasized the challenges clinicians face in identifying them.

In this case, the authors suggested the plastic was visible on CT partly because of its material properties and partly because surrounding inflammation and abscess formation made the area more noticeable. Even so, its transparency, small size, and deep location within inflamed tissue made it difficult to interpret on scans and nearly impossible to find visually during surgery.

Missing such an object can have serious consequences. Deep neck infections can spread into the chest and cause mediastinitis, a life-threatening condition with a reported death rate of 20% to 40%, according to a 2014 case report cited by the authors. A StatPearls review of neck abscesses describes deep neck infections as surgical emergencies and links earlier operations with better outcomes.

The Austrian team offered a practical lesson for surgeons: when imaging continues to suggest a foreign body that cannot be seen during an operation, careful palpation of the surrounding tissue may reveal it. They also advised clinicians to consider migrated objects in patients with persistent symptoms or unexplained neck infections.

For the public, the case underscores the importance of prompt medical care for worsening swallowing problems, especially when accompanied by fever, neck pain, or swelling.

Key Questions Answered

What did doctors find in the woman’s neck?

They removed a clear, rigid plastic fragment about 30 millimeters long with sharp edges. It was located in the prevertebral space, the tissue area in front of the cervical spine.

Why could surgeons not find it during the first two operations?

The shard was thin, transparent, and buried in inflamed, pus-filled tissue. It was ultimately discovered by touch during a third operation.

How did the plastic get into her neck?

The exact cause is unknown. She did not recall swallowing anything, and endoscopy found no injury. The authors believe accidental swallowing followed by migration is the most likely possibility, but they described that explanation as speculative.

What is a prevertebral abscess?

It is a collection of infected fluid in the tissue in front of the spine. Deep neck infections of this kind can become life-threatening if they spread into the chest.

Did the patient recover?

Yes. Her inflammatory markers decreased, her swallowing problem resolved, and she was discharged home. Because no scheduled follow-up occurred, long-term outcomes remain unknown.

When should someone seek care for swallowing problems?

Worsening difficulty swallowing, particularly with fever, neck pain, or swelling, should be evaluated promptly by a clinician. Anyone experiencing trouble breathing should seek emergency care.

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