Triage: STRUCK @ LEFT SIDE OF NECK/HEAD AREA – VOICE CHANGE/SOUNDS MORE NASAL – THROAT FEELS TIGHT/CONSTRICTED.
History of Present Illness: This is a 15-year-old male who around 1040 today while playing lacrosse in a tournament got hit in his left clavicle and the pulled and went up sort of towards his throat. He was able to keep playing but about an hour and a half or 2 hours later he started noticing of voice change and then some pain down into his chest. He is not short of breath and does not have any weakness and has not coughed up any blood and is handling secretions fine but he has ongoing symptoms prompting the visit here.
Vital Signs: T: 37.1 °C, HR: 71, RR: 16, BP: 115/70, SpO2: 98%
Physical Exam: Mild dysphonia. Handling secretions well. No carotid bruit or Horner syndrome. Lungs clear and symmetric. Heart sounds normal without Hamman’s crunch. Mild bruising to left clavicle without deformity
Diagnostic Testing:
- Two cuts of CT shown below
What is the most likely diagnosis?
- A) Carotid dissection
- B) Expanding neck hematoma
- C) Pneumomediastinum
- D) Laryngeal fracture
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What is the most likely diagnosis?
- A) Carotid dissection
- B) Expanding neck hematoma
- C) Pneumomediastinum – CORRECT – CT shows air (black) around R > L carotid and posterior to airway
- D) Laryngeal fracture
1-Minute EM Consult on the topic for this case – click here
Audio of Hamman’s crunch – click here
CASE CONCLUSION: Transferred to trauma center. ENT did laryngoscopy, which was negative, observed for 24 hours with gradual improvement and sent home the next day