A 43-Year-Old Man With Neck Swelling and Dyspnea

Alexander B. Norinsky, DO; Andrew Caravello, DO; James Espinosa, MD

Disclosures

February 09, 2016

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 43-year-old man who is nontoxic but somewhat uncomfortable presents to the emergency department (ED) with a chief complaint of dyspnea secondary to swelling in his left neck region. He also has progressive difficulty tolerating his secretions and swallowing. He initially noted the swelling earlier that night while trying to eat dinner when he was unable to swallow. He also describes his voice becoming progressively muffled over the past few days and foul-smelling breath.

He denies any fevers, chills, sore throat, congestion, rhinorrhea, pain elsewhere, and any other complaints. No recent history of tooth extractions or dental procedures is reported. He has never experienced anything similar and, prior to this event, reports being in his normal state of health without any illnesses or known sick contacts or exposures.

He has no significant medical history; however, he has not seen a primary care physician in more than 10 years. The patient denies any surgeries, and family history is unavailable because he was adopted and unaware of the health status of his biological parents. Social history is significant for smoking one pack of cigarettes daily for about 15 years, without any illicit drug or alcohol abuse. He has no known drug allergies and takes no medications on a daily basis.

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