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Clinical Problem Solving: Radiology |

Radiology Quiz Case 1

Charbel Rameh, MD; Marwan Youssef, MD; Sami Husseini, MD; Abdul-latif Hamdan, MD
Arch Otolaryngol Head Neck Surg. 2007;133(11):1162. doi:10.1001/archotol.133.11.1162.
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A 43-year-old man with colon cancer underwent a low anterior resection with a right colectomy and iliotransverse anastomosis in November 2003, followed by 12 cycles of chemotherapy. Two years later, follow-up colonoscopy revealed that the tumor had recurred, so the patient underwent a total colectomy, a partial gastrectomy, and multiple small-bowel resections with gastrojejunostomy and duodenojejunostomy. A total parenteral nutrition regimen was initiated on postoperative day 2 after a right subclavian central line was inserted with the patient under local anesthesia. Four days later, he complained of a progressively growing left submandibular mass. He was febrile and had a white blood cell count of 16 600/μL and a differential neutrophil count of 93%. Therapy with an injectable antibacterial combination agent (Tazocin) was begun; however, the mass continued to grow. On physical examination, it measured 2×2 cm and was soft, fluctuant, and very tender to palpation. The overlying skin was erythematous and warm. Intraorally, there was clear salivary discharge from the Wharton duct. The patient denied any history of tooth abscess formation. Computed tomography of the neck with contrast was performed (Figure 1 and Figure 2).

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