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Woman With Neck Pain

      A 55-year-old woman presented with 24 hours of neck pain, odynophagia, and painful foreign body sensation that began while she ate a sandwich. Vital signs were normal. Physical examination showed a nontoxic woman, muffled voice, clear oropharynx, and pain with neck extension. WBC count was 18.8×103/μL. Neck computed tomography (CT) was obtained (Figure 1). Clindamycin and dexamethasone were given intravenously, and an otolaryngologist performed direct laryngoscopy in the operating room (Figure 2).
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      Figure 1CT of neck soft tissue with intravenous contrast in sagittal (A) and axial (B) views. There was retropharyngeal swelling with fluid (yellow arrow) and gas collections (blue arrows).
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      Figure 2Direct laryngoscopy of the lower oropharynx. The epiglottis (red arrow) is seen with endotracheal tube passing underneath. A wooden foreign body (blue arrow) is seen penetrating the posterior oropharyngeal wall, with surrounding purulence (yellow arrow).
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