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Case vignette
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.
Key questions
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What is your differential diagnosis?
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What are the appropriate tests to obtain in this patient?
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What does the CT imaging show; does this change or narrow your differential diagnosis?
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What is …
Footnotes
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Competing interests None.
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Provenance and peer review Commissioned; internally peer reviewed.
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