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Clinical Challenge
Radiology
January 2016

A Young Man With Chronic Discharge From the Skin of the Lateral Neck

Author Affiliations
  • 1Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 2Department of Otolaryngology, University of California, San Francisco
  • 3Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
JAMA Otolaryngol Head Neck Surg. 2016;142(1):99-100. doi:10.1001/jamaoto.2015.3044

A man in his early 20s presented to the otolaryngology clinic with a history of a small opening in the left lateral side of the neck that produced chronic purulent discharge. Despite several previous attempts at surgical resection, the drainage had persisted for 6 years. Initial computed tomography (CT) identified infiltration of the subcutaneous tissues in the left side of the neck anterior to the strap muscle at the level of the larynx, without discrete abscess. Computed tomography also showed a small tract that extended from the skin of the lateral side of the neck to the left strap muscles. The patient was referred to radiology, where a 22-gauge intravenous access catheter was inserted into the draining puncta. Isovue-300 was infused under conventional fluoroscopic guidance (Figure, A). When the patient stated that he tasted contrast material, the infusion was terminated, and the patient was transferred to the CT service, where axial images of the neck were obtained and reformatted in multiple planes (Figure, B and C).

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