Unusual swelling of the neck and face

Introduction The differential diagnoses for swelling in the head and neck area are manifold. Subcutaneous emphysema in the facial area can occur after fractures of the facial skull or paranasal sinuses. Dental treatments, lung injuries or perforations in the tracheobronchial system, pharynx or esophagus can also be the cause. Wound infections with anaerobes can lead to emphysema due to carbon dioxide formation.

Case report A 65-year-old overweight patient is referred with a massive swelling of the neck and face. Assuming an allergic reaction, dexamethasone and dimetids had been administered, which did not result in a decrease. The patient had noticed a slowly progressive swelling since 4 days. Allergies are not known. The patient reported thoracic pain on the right side for the first time 6 weeks ago, why he had been prescribed Voltaren and Cortisone according to orthopedic recommendation.

Results The computed tomography of the neck revealed pronounced diffuse soft tissue emphysema of the face, neck and thorax. The computed tomography of the thorax demonstrated a pneumothorax on the right side and a fresh dislocated 7th and 8th rib fracture. There were pneumomediastinum, pneumopericard and soft tissue emphysema of the thorax and the upper abdomen.

Discussion The thoracic surgeons performed the thoracotomy with thoracic wall reconstruction, reposition of the costal arches and atypical partial lung resection. Retrospectively, the patient reported on an osteopathic treatment, in which a fracture may have occurred. The case report focuses our attention on considering minor injuries. If the cause of the swelling is not obvious, imaging should always be considered. In addition, especially in the case of atypical symptoms, the perspective should extend beyond one's own specialty.

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Artikel online veröffentlicht:
24. Mai 2022