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Image challenge
Neck stiffness and dysphagia
  1. Rene Monzon,
  2. Paul Jhun
  1. Emergency Medicine, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Rene Monzon, Emergency Medicine, University of California San Francisco, San Francisco, CA 94110, USA; rene.monzon{at}ucsf.edu

https://doi.org/10.1136/emermed-2021-212070

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    Clinical introduction

    A 72-year-old man with a history of diabetes mellitus and glottic squamous cell carcinoma in remission presented to the ED with sore throat and neck stiffness for 5 days.

    The patient reported sore throat and posterior neck pain worse with flexion and rotation. The morning of his presentation, he developed dysphagia and dyspnoea. He denied fever, trauma or recent sick contacts.

    Physical examination revealed mild inspiratory stridor. Oropharyngeal examination showed symmetric palate elevation, no uvular deviation, and no tonsillar exudate or erythema. The posterior neck was mildly tender to palpation.

    Lateral neck X-ray was performed (figure 1).

    Figure 1

    Lateral neck X-ray.

    Question

    Which of the following are you most concerned about?

    1. Angioedema …

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    Footnotes

    • Twitter @jhunlikefun

    • Contributors RM and PJ provided and cared for the patient in this image challenge/case report. RM and PJ critically reviewed this image challenge/case report. RM and PJ both participated in writing up this image challenge/case report.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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