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Clinical Problem Solving: Radiology
April 2004

Radiology Quiz Case 2—Diagnosis

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Copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2004

Arch Otolaryngol Head Neck Surg. 2004;130(4):482-483. doi:10.1001/archotol.130.4.482

The patient was taken to the operating room for a neck exploration, which revealed a fetid odor and bilateral necrosis of his sternocleidomastoid and strap muscles, which were aggressively debrided. He had bilateral chest tubes placed for drainage and underwent dental extractions. He was also treated with broad-spectrum antibiotics. The cervical skin flaps were kept open, debrided twice a day, and loosely packed with gauze soaked with half-strength hydrogen peroxide. He subsequently developed a pharyngocutaneous fistula, which was treated conservatively with packing and pressure dressings. Cultures yielded Peptostreptococcus species, Enterococcus, Clostridium difficile, Eikenella corrodens, and Candida albicans, and his antibiotic therapy was appropriately modified based on the culture sensitivities. He remained in the hospital for 5 weeks, after which he was transferred to a rehabilitation center. He subsequently underwent decannulation and is currently swallowing without any difficulty.

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