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A 15-YEAR-OLD boy presented with a 1-year history of a bilateral neck mass that had been aggravated by trumpet playing. He had a chronic cough due to asthma and used metered-dose inhalers regularly. Physical examination showed no abnormalities of the neck until the patient did a Valsalva maneuver, which showed well-defined bilateral neck swelling anterior to the sternocleidomastoid muscle and adjacent to the superior border of the thyroid cartilage.
Sequential computed tomographic scans of the neck obtained during the Valsalva maneuver (Figure 1 and Figure 2) showed air-filled cavities extending into the subcutaneous tissues of the neck.
Babb MJ, Rasgon BM. Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2000;126(4):551. doi: