Case 2: Neck Pain, Neck Swelling, and Chest Pain in a 17-year-old Boy.

Abstract

1. Onyekachukwu Osakwe, MD* 2. Bahareh Keith, DO* 1. *Department of Pediatrics, University of Florida, Gainesville, FL A 17-year-old, previously healthy boy presents to the pediatric emergency department (ED) with shortness of breath, neck pain, neck swelling, and dysphagia, which started earlier that morning when he woke up from sleep. There is no history of fever, cough, choking, vomiting, or trauma. He reports that he had vigorously cheered while watching the Super Bowl football game the preceding day. He is a track runner but had not engaged in any strenuous activities for 3 days before the onset of his symptoms. He does not smoke or use any other drugs. Despite the neck pain and swelling in the morning, he went to school. The neck swelling, however, worsened with fits of laughter at school, and he developed some shortness of breath during track practice, prompting a visit to the pediatric ED. His vital signs on admission are as follows: respiratory rate, 21 breaths/min; heart rate, 68 beats/min; blood pressure, 127/73 mm Hg; oxygen saturation, 100% on room air; and temperature, 97.9°F (36.6°C). On physical examination, he has a marfanoid habitus (tall and thin), with a BMI of 16, but there is no ectopia lentis or abnormal curves in the spine that would suggest Marfan syndrome. There is palpable crepitus on the neck above the clavicles on both sides, extending downward on the anterior chest, over the sternum, to the level of the fourth rib. Breath sounds are normally heard. Pleural rub is heard over both lungs. Heart sounds are normally heard, along with a crunching sound synchronous with each heartbeat. Imaging studies confirm the diagnosis. Chest radiograph showed evidence of pneumomediastinum, with air tracking along …