Adolescent with painful swallowing

Clinical introduction A healthy 16-year-old boy presented with a 3-day history of odynophagia. This occurred after a football struck his anterior chest and neck region. The odynophagia radiated to the retrosternal area. Dysphagia, dyspnoea and fever were not noted. His only abnormal vital sign was an RR of 24 beats per minute. His neck appeared normal, and his voice exhibited clarity and normal pitch without hoarseness or stridor. The chest radiogram (CXR) was normal. Lateral view neck radiography was performed (figure 1). Question What is the most likely diagnosis? Hyoid bone fracture Retropharyngeal haematoma Pneumomediastinum Oesophagus rupture Answer: C The lateral neck radiograph revealed prevertebral soft-tissue radiolucent tracking, indicative of free air (figure 2). In collision sports, pneumomediastinum occurs rarely, primarily attributed to the Macklin effect. This involves alveolar rupture, causing air dissection along the bronchovascular...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: EMJ Image Challenge Source Type: research