Threatened Injury of the Vertebral Artery Following Ingestion of a Needle

A 53-year-old woman reported a foreign body sensation and sore throat after eating spaghetti bolognese. Five days after the meal in question, the patient was admitted to the hospital with increasing dyspnea and pain radiating to the neck and shoulders. Oral examination revealed obvious swelling of the lateral oropharyngeal and hypopharyngeal wall, more pronounced on the right. Contrast-enhanced computed tomography showed early abscess formation in the parapharyngeal space and a radiodense, needle-shaped foreign body with its point adjacent to the right vertebral artery in the transverse foramen, at the level of C 4/5. There was no evidence of bleeding at this time. In view of the critical proximity to the dominant vertebral artery and the danger of injury to the vessel wall, the foreign body was removed under angiographic guidance. The ingested object was indeed a needle, with a short length of thread attached. After angiographic exclusion of vascular damage, the patient was taken to the operating room for abscess drainage. Whether foreign body ingestion in this case was intentional or accidental remained unknown. Pre-existing pathology may predispose to oropharyngeal impaction.

Translated from the original German by David Roseveare.

Cite this as: Henkelmann J, Schob S, Rudolph J: Threatened injury of the vertebral artery following ingestion of a needle.

Figure 1.

a) An axial CT scan at the level of C 4/5 shows the needle with its point adjacent to the right vertebral artery in the transverse foramen. Distinct prevertebral soft-tissue swelling is also seen. b) 3D reconstruction