Image of the month: wooden branch ingestion crossing the mediastinum

A 33-year-old patient was managed in the emergency room. After right thoracic drainage for a pneumothorax, intubation for hypoxemia, and extraction of wooden foreign bodies from his mouth, a full-body scan identified a 6 mm diameter tubular-shaped structure extending from the nasopharynx to the retroperitoneum, passing through the mediastinum, in between major cardiovascular structures and organs. Cardiothoracic surgeons performed a sternotomy to remove the foreign body, which was identified as a long tree branch, without finding any major collateral anatomical damage. The cause of this ingestion was attributed to psychiatric delirium. Post-operative care included prolonged antibiotic therapy, one drainage surgery, and intensive rehabilitation, ultimately leading to a slow and progressive recovery. This unique case of tree branch ingestion crossing the mediastinum in an adult is astounding as the patient survived remarkably this life-threatening self-inflicted trauma. Furthermore, this case highlights the critical role of multidisciplinary management, the importance of imaging, and the emphasis on coordinated medical efforts to achieve positive outcomes in similar self-inflicted multiple site injuries cases.