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Clinical Problem Solving: Radiology
June 2007

Radiology Quiz Case 2: Diagnosis

Author Affiliations

Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Otolaryngol Head Neck Surg. 2007;133(6):617-618. doi:10.1001/archotol.133.6.617

This case posed a diagnostic dilemma: was the cervical emphysema related to the subglottic rhinoscleroma? Or was this subglottic mass merely a coincidental finding? The entry point of air into the subcutaneous tissues was not located on examinations (including direct laryngoscopy, bronchoscopy, and esophagoscopy) or detected by computed tomography, which made answering these questions quite difficult.

Cervical emphysema has an extensive list of differential diagnoses. Most commonly, it is seen as a result of either internal or external trauma to the aerodigestive tract or surgery. Pathophysiologically, air dissects from the aerodigestive tract either directly or via the mediastinum into cervical soft tissues. Several other pathogenetic factors, including neck abscess, dental surgery, posttracheotomy, posttonsillectomy,1 and mechanical ventilation, have been noted in the literature. The diagnosis of spontaneous cervical emphysema is given when there is no readily identifiable cause. Clinically, patients present with dysphagia, neck swelling, chest pain, sore throat, dyspnea, and neck pain. Treatment usually involves bed rest and analgesics, as most episodes are self-limited. However, the possibility of an esophageal rupture, tension pneumothorax, ruptured laryngocele, or foreign body must be ruled out.2