Differential Diagnosis

  • Allergic reaction
  • Hematoma
  • Inflammation
  • Soft tissue emphysema
  • Soft tissue infection

Diagnosis

This patient was diagnosed with soft tissue emphysema, which can cause discomfort—what this patient perceived as a foreign body sensation. In this case it arose from pneumomediastinum tracking into the neck soft tissues (confirmed on the subsequently performed chest radiograph).

 

Learnings/What to Look for

  • Streaky hypodensities in the soft tissues of the neck compatible with gas
  • This was like secondary to raised intrathoracic pressure from coughing after choking on food. Other possibilities for soft tissue emphysema include penetrating trauma and infection with a gas forming organism

 

Pearls for Urgent Care Management and Considerations for Transfer

  • Transfer to the ED for consideration of CT imaging to evaluation for perforation, Boerhaave’s syndrome
  • If the patient is hemodynamically unstable, start IV access and IV fluid resuscitation while awaiting transfer

 

Acknowledgment: Images courtesy of Teleradiology Specialists.

 

A 9-Year-Old Girl Who Choked on a Chicken Nugget
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