Triage Note: STRUCK @ SIDE OF NECK. VOICE SOUNDS NASAL. THROAT FEELS TIGHT.
History of Present Illness: A 15-year-old male who was playing lacrosse got hit in his left clavicle up towards his throat. He was able to keep playing but about 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. He has not coughed up any blood and is handling secretions fine but has ongoing symptoms prompting the ER visit.
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 Neck shown below
What is the most likely diagnosis?
- A) Carotid dissection
- B) Expanding neck hematoma
- C) Pneumomediastinum
- D) Laryngeal fracture
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
<<<<<<<<<<<<<<<<<<<<< ADVERTISEMENT & SPACER >>>>>>>>>>>>>>>>>>>>>
****************************************************************************
THE EMERGENCY MEDICINE POCKETBOOK TRIFECTA
- Emergency Medicine 1-Minute Consult, 5th edition
- A-to-Z EM Pharmacopoeia & Antibiotic Guide, 5th edition
- 8-in-1 Emergency Department Quick Reference, 5th edition
******************************************************************************
<<<<<<<<<<<<<<<<<<<<<<<<< END SPACER >>>>>>>>>>>>>>>>>>>>>>>>>
-
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 the nearby trauma center. ENT did laryngoscopy, which was negative, and observed for 24 hours. He had gradual improvement and was sent home the next day