A 27 year old patient has had a sore throat for the past 10 days. He received antibiotics from his primary care physician without a lot of improvement. He comes in on a Saturday because he is out of antibiotics and wants a refill.
He doesn’t appear uncomfortable. He doesn’t have any problems swallowing. No fever. He does have pain on the left side of his neck along a swollen lymph node. It hurts for him to turn his head to the left. On exam, his throat is red, but there is no pus and his airway is patent. There are several swollen and tender lymph nodes in the neck. He complains of pain turning his head to the left side. He doesn’t have any signs of meningitis. Nothing else seems abnormal on his physical exam.
Think about what your differential diagnosis would be and what you’d do to work the patient up … if anything.
Now look at the x-ray below. What is the calcified foreign body in the front of his neck? Are there any other abnormalities? What other test(s) would you do and who would you call?
Scroll down for answers and other pictures.
The calcified foreign body in the front of the neck is actually the hyoid bone. Coroners look to see whether this bone is intact during autopsy since a broken hyoid bone suggests that strangling took place.
The neck x-ray shows prevertebral soft tissue swelling. Remember 7 mm at C2 and 22mm at C7. Got the diagnosis now?
CT scans of the neck below.