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Image challenge
A woman with swelling of the neck
  1. Shinichiro Ienaga1,
  2. Akira Kuriyama2,
  3. Seigo Urushidani1
  1. 1 Department of Emergency Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
  2. 2 Department of General Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
  1. Correspondence to Dr Akira Kuriyama, Department of General Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan; nrk40448{at}nifty.com

http://dx.doi.org/10.1136/emermed-2015-205557

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    Clinical introduction

    A 79-year-old diabetic woman presented with a 4-day history of trismus and progressive submandibular pain. Physical examination revealed a tender induration with redness in the submandibular region (figures 1 and 2).

    Figure 1

    Induration with redness in the submandibular region.

    Figure 2

    Induration with redness in the submandibular region.

    Question

    What is your differential diagnosis?

    1. Submandibular gland tumour

    2. Tetanus

    3. Viral submandibular adenitis

    4. Submandibular cellulitis …

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    Footnotes

    • Contributors All authors looked after the patient, wrote the manuscript, and approved the submission of the current manuscript.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.