Neck Crepitus in a Runner
Am Fam Physician. 2017 Jan 15;95(2):113-115.
A 27-year-old man presented with constant right-sided neck, throat, and ear pain that began one day earlier after he completed an uneventful five-mile trail run. There were no alleviating or exacerbating factors for the pain. He did not have trauma or injury to the area. He reported a vague sensation of fluid moving around in his neck and a strange feeling in his throat with swallowing. He did not have dysphagia, odynophagia, fever, chills, or respiratory symptoms. He did not use drugs or alcohol.
On physical examination, he was well appearing with normal vital signs and normal oxygen saturation on room air. An ear examination was normal. The neck examination revealed minimally palpable crepitus at the right lateral aspect of the base of the neck. There was no skin warmth or erythema. Soft tissue neck radiography was performed (Figure 1 and Figure 2).
Based on the patient's history, physical examination, and radiography findings, which one of the following is the most likely diagnosis?
A. Esophageal rupture.
B. Retropharyngeal abscess.
C. Spontaneous gas gangrene.
D. Spontaneous pneumomediastinum.
E. Spontaneous pne
REFERENCESshow all references
1. Huon LK, Chang YL, Wang PC, Chen PY. Head and neck manifestations of spontaneous pneumomediastinum. Otolaryngol Head Neck Surg. 2012;146(1):53–57....
2. Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous and mediastinal emphysema. Pathophysiology, diagnosis, and management. Arch Intern Med. 1984;144(7):1447–1453.
3. Murad AA. Spontaneous pneumomediastinum. BMJ Case Rep. 2011;2011
4. Triadafilopoulos G. Boerhaave syndrome: effort rupture of the esophagus. UpToDate. http://www.uptodate.com/contents/boerhaave-syndrome-effort-rupture-of-the-esophagus (subscription required). Accessed February 15, 2015.
5. Wald ER. Retropharyngeal infections in children. UpToDate. http://www.uptodate.com/contents/retropharyngeal-infections-in-children?source=machineLearning&search=Retropharyngeal+infections+in+children (subscription required). Accessed February 15, 2015.
6. Stevens DL, Bryant A. Clostridial myonecrosis. UpToDate. http://www.uptodate.com/contents/clostridial-myonecrosis (subscription required). Accessed February 15, 2015.
7. MacDuff A, Arnold A, Harvey J; BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65(suppl 2):ii18–ii31.
This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.
A collection of Photo Quiz published in AFP is available at http://www.aafp.org/afp/photoquiz.
Previously published Photo Quizzes are now featured in a mobile app. Get more information at http://www.aafp.org/afp/apps.
The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at http://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. E-mail submissions to firstname.lastname@example.org.
Copyright © 2017 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions