Widespread ST segment elevation and elevated troponin: unveiling an uncommon cause

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Esophageal perforation with pericardial penetration (n=1). Intervention: Thoracoscopy and open thoracotomy. Primary outcome: Resolution of symptoms and ECG abnormalities.

Q: What does this research mean for the field?

Esophageal perforation from an ingested foreign body can present with widespread ST segment elevation and elevated cardiac troponin, mimicking acute myocardial infarction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Fei Wang; Ziyi Sun

doi:10.1186/s13019-026-03989-y

April 3, 2026Journal of Cardiothoracic SurgeryOpen Access

Widespread ST segment elevation and elevated troponin: unveiling an uncommon cause

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Key Points

To report a rare case where esophageal perforation from an ingested fish bone presented with widespread ST segment elevation and elevated troponin, mimicking acute myocardial infarction.
Evaluated an 82-year-old male presenting with a 3-day history of postprandial retrosternal chest pain, diffuse ST segment elevation, and elevated cardiac biomarkers.
Conducted emergency chest computed tomography (CT) imaging after medical history revealed symptom onset coincided with fish bone ingestion.
Performed thoracoscopic surgery to inspect myocardial puncture, repair esophageal and pericardial tears, and place active drainage.
Laboratory testing at admission identified cardiac troponin I levels of 2.475 ng/mL (reference range <0.01 ng/mL) and myoglobin of 56.78 ng/mL (reference range 0-18 ng/mL).
Emergency chest CT and thoracoscopic exploration confirmed esophageal perforation in the lower segment of the esophagus, pericardial penetration, pericardial effusion, and pneumopericardium.
Following thoracoscopic repair and drainage, the patient experienced normalization of the electrocardiogram, gradual decline of cardiac biomarkers, and full clinical recovery.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

82-year-old male with a 3-day history of intermittent chest pain, hypertension, and occasional smoking, presenting with widespread ST segment elevation and elevated troponin.

I

Intervention

Emergency surgical intervention involving thoracoscopy and open thoracotomy to remove fish bone fragments, with pericardial and pleural drainage.

O

Outcome

Resolution of chest pain, improvement in pericardial effusion, and normalization of ECG findings and cardiac biomarkers.

Esophageal perforation from a foreign body can mimic acute myocardial infarction by causing pericardial injury, widespread ST-segment elevation, and elevated troponin levels.

Implication

Prompts inclusion of esophageal foreign body perforation in AMI differential; extends etiologies for ST-elevation with troponin rise.

Abstract

This article describes a case involving a patient who presented with chest pain persisting for three days, elevated levels of cardiac troponin, and widespread ST segment elevation in the ECG leads. Subsequent diagnosis revealed esophageal perforation resulting from the accidental ingestion of a fish bone, leading to pericardial effusion and pneumopericardium. This case highlights the importance of healthcare professionals conducting a comprehensive investigation of the patient’s medical history when confronted with widespread ST segment elevation and elevated cardiac troponin levels to avoid misdiagnosis and mitigate potential serious consequences.

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Cite This Study

Wang et al. (2026) conducted a case report in Esophageal perforation with pericardial penetration (n=1). Thoracoscopy and open thoracotomy was evaluated on Resolution of symptoms and ECG abnormalities.

synapsesocial.com/papers/69d1fcfda79560c99a0a2bd9 https://doi.org/10.1186/s13019-026-03989-y

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Widespread ST segment elevation and elevated troponin: unveiling an uncommon cause

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Widespread ST segment elevation and elevated troponin: unveiling an uncommon cause

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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