Diagnosis: Fishbone lodged in oropharynx.

Presentation: Typically as above, well appearing with sometimes having just eaten a meal. Patient may present with a feeling of something stuck.

Imaging of choice:

• Plain films are typical first choice (sensitivity around 35%)
• CT has a sensitivity of 95% for bones
• Plain films have lower sensitivity for organic matter, if available ultrasound can be used.  

Treatment: Admit for medical monitoring.

Disposition: Admit to floor/ICU depending on airway status. This patient was admitted to the pedediatric intermediate care unit and observed overnight for non-emergent bronchoscopy. The bone had left spontaneously on re-imaging the next day.

References:
1. http://radiopaedia.org/articles/ingested-bones
2. Knght LC, Lesser TH. Fish bones in the throat. Arch Emerg Med. 1989;6 (1): 13-6
3. Goh BK, Tan YM, Lin SE et-al. CT in the preoperative diagnosis of fish bone perforation of the gastrointestinal tract. AJR Am J Roentgenol. 2006;187 (3): 710-4.