Case 1: Neck Swelling in a Neonate

Abstract

A 32-day-old term African American male infant presents to the emergency department with a 1-day history of congestion and fussiness. The mother notes that his 2 siblings had a cold about 2 weeks ago, but she denies fever, cough, vomiting, diarrhea, and rashes. The infant has been breastfeeding without issues and has had a normal number of voids/stools. Earlier that morning, the infant had been taken to his pediatrician’s office for his fussiness and was prescribed simethicone for possible gas-related symptoms. Later that afternoon, the infant’s father had noted neck swelling on the right that spread toward the left side and he was brought to the emergency department. His initial vital signs include a rectal temperature of 100.5°F (37.7°C), heart rate of 194 beats/min, respiratory rate of 46 breaths/min, oxygen saturation of 98% on room air, and a blood pressure of 98/50 mm Hg. The patient is well appearing and in no acute distress. His lungs are clear to auscultation, a II/VI systolic murmur is heard best at the left sternal border, and abdominal examination findings are normal. He has submental/neck fullness (right greater than left) with no erythema, warmth, masses, or fluctuance noted. No lymphadenopathy is appreciable on examination. On further history taking, the mother states that the neonate was born at 38 …