A 37-year-old male patient was admitted to the hospital with repeated fever for 15 days and right limb weakness for 7 + hours. Brain magnetic resonance imaging with diffusion-weighted imaging showed multiple high signal intensities in the bilateral cerebral hemisphere, consistent with the performance of cerebral infarction (Panels A and B). Transthoracic echocardiography revealed an ovoid, hypoechoic, mobile mass (19 mm × 17 mm) (green arrow) in the left atrium attached to the root of the anterior leaflet of the mitral valve with no significant valvular abnormalities, and an hyperechoic, immobile mass (24 mm × 26 mm) (red arrow) at the left atrium posterior wall (Panels C and D). Because of its echographic features suggestive of mobile mass, cerebral embolisms originated from the heart were diagnosed. The enhanced chest computed tomography revealed a long strip-shaped high-density shadow pierced the left atrium surrounded by an irregular mass and the fusiform filling defect at the left atrium (Panels E and F). The patient underwent surgery. A fishbone penetrating through the oesophageal wall, piercing the left atrium was confirmed (Panel G). Around the fishbone, a greyish-white mass (30 mm × 30 mm × 20 mm) and a solid cystic mass (20 mm × 20 mm × 20 mm) with a small amount of pus and gas were found at the left atrial posterior wall. On histological examination, the left atrial mass revealed neutrophil infiltration and the foreign body is a necrotic and slightly degenerated bone tissue with neutrophil infiltration (Panels H and I).

中文翻译：

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鱼骨引起的脑栓塞

一名37岁男性患者因反复发热15天、右肢无力7+小时入院。脑磁共振弥散加权成像显示双侧大脑半球出现多个高信号强度，与脑梗塞的表现一致（图A和图B）。经胸超声心动图显示左心房有一个卵圆形、低回声、可移动的肿块（19 mm × 17 mm）（绿色箭头），附着于二尖瓣前叶根部，无明显瓣膜异常，以及一个高回声、固定的肿块（绿色箭头）。 24 mm × 26 mm）（红色箭头）在左心房后壁（图 C和D）。由于其超声特征提示有活动性肿块，因此诊断为源自心脏的脑栓塞。增强的胸部计算机断层扫描显示一个长条状的高密度阴影刺穿了左心房，周围有不规则的肿块和左心房的梭形充盈缺损（图 E和F）。患者接受了手术。证实有一条鱼刺穿过食管壁，刺穿左心房（图 G）。鱼骨周围，左房后壁见灰白色肿物（30 mm×30 mm×20 mm）和实性囊性肿块（20 mm×20 mm×20 mm），伴有少量脓气。 . 在组织学检查中，左心房肿块显示中性粒细胞浸润，异物是一种坏死且轻度退化的骨组织，伴有中性粒细胞浸润（图 H和I）。