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).
      Figure thumbnail gr1
      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).
      Figure thumbnail gr2
      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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