Acute onset swelling of the cervical tissue

Introduction:

An otherwise healthy 31-year-old female patient presents in emergency department with a mild degree of dysphagia due to a diffuse swelling of her left cervical tissue, with no change in skin color. She reports vomiting as a passenger from a car the day before.

Methodology:

Clinical examination reveals an asymmetry of the neck with a massive, soft palpable swelling of the left side of the neck without overheating or reddening.

The B-scan sonography presents a tumor with diffuse, hyperechoic thickening of the cervical soft tissue. Furthermore, a contrast-enhanced computed tomography is performed.

Results:

This CT investigation impresses a diffuse, pulling up into the upper mediastinum distension of the left cervical soft tissue mantle, fitting to a hematoma with space-occupying effect on the esophagus and trachea. In addition, the hemoglobin level drops from 13.3 to 9.9 g/dl. Interventional diagnostics and therapy were not considered due to the consistently recurrent findings until restitutio ad Integrum.

Discussion:

Acute onset swelling of the cervical tissue is a diagnostic challenge due to the potential risk of airway obstruction. A timely targeted diagnosis is necessary for a customized treatment.

Pressure increase by vomiting with simultaneous rightward rotation and concomitant hyperextension of the opposite side can, as in this case, lead to the rupture of a small vein (most likely the external jugular vein) with consecutive hemorrhage.

Publication History

Publication Date:
23 April 2019 (online)