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A middle aged man presents to the emergency department (ED) with right-sided neck pain and swelling. He had a right internal jugular vein (IJ) catheter during a hospitalisation for intestinal haemorrhage 2 weeks ago. Shortly thereafter, the patient noted progressively worsening neck pain and swelling, with dysphagia, odynophagia and pain with neck movement over the last 2 days. The patient denies fevers, chills, vocal changes, respiratory distress, dyspnoea, chest pain or recent drug use. On exam, the patient appears uncomfortable, with a blood pressure 133/74, heart rate 108 BPM, respiratory rate of 16, pulse oximetry of 100% and temperature of 36.6°C. He has swelling and tenderness to palpation of the right neck and right lower jaw.
What is your differential diagnosis?
What are the appropriate tests to obtain in this patient?
What does the CT imaging show; does this change or narrow your differential diagnosis?
What is …
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