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Clinical Problem Solving: Radiology |

Radiology Quiz Case 1

Hsuan-Yeh Fang, MD; Shiang-Fu Huang, MD, PhD; Shy-Chyi Chin, MD; Yi-Chou Wang, MD; Shian-Sen Shie, MD
JAMA Otolaryngol Head Neck Surg. 2013;139(3):307. doi:10.1001/jamaoto.2013.19.
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An 84-year-old woman presented with a 3-week history of painful swelling on the right side of the neck accompanied by pain on the right side of the face and fever. There were no other symptoms in the head and neck region, including sore throat, dysphagia, dyspnea, purulent rhinorrhea, or cough. She had underlying diseases (hypertension, type 2 diabetes mellitus, and chronic obstructive pulmonary disease), which were controlled with medications. A physical examination revealed a swelling on the right side of the neck extending from the level of the hyoid bone to the right cheek, with tenderness, erythema, and local heat. No obvious abnormalities were found in the nasopharynx, oropharynx, or cranial nerves. No trauma, dental procedure, sinus surgery, cancer, or significant family history were noted. Results from a blood test showed a leukocyte count of 17 900/uL with 86% neutrophils and an elevated C-reactive protein level of 126.44 mg/L. (To convert leukocyte count to × 109/L, multiply by 0.001; to convert C-reactive protein to nanomoles per liter, multiply by 9.524.) Under the impression of a deep neck infection, computed tomography (CT) of the head and neck region was performed, and the image is shown in Figure 1.

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