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

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.