History of Present Illness:
A man in his late 60’s with opiate dependent chronic neck pain and who denies a history of COPD but is a chronic smoker is brought by medics to the ER for 2 days of worsening SOB and cough. He denies fever, chest pain or other complaints
Vital Signs & Physical Exam:
Pulse ox 90%, tachypneic, mild inspiratory and expiratory wheezes versus stridor
Initial Diagnostic Testing:
What is the most likely diagnosis?
- A) COPD
- B) Epiglottitis
- C) Retropharyngeal abscess
- D) Osteomyelitis
- E) Foreign body
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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THE EMERGENCY MEDICINE POCKETBOOK TRIFECTA
Emergency Medicine 1-Minute Consult, 5th edition
A-to-Z EM Pharmacopoeia & Antibiotic Guide, 5th edition
8-in-1 Emergency Department Quick Reference, 5th edition
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ANSWER:
- A) COPD
- B) Epiglottitis
- C) Retropharyngeal abscess – CORRECT (ALMOST)
- D) Osteomyelitis
- E) Foreign body
1-Minute Consult on this topic: Click HERE and scroll to page 79.
CASE CONCLUSION: There is swelling of the soft tissues anterior to the lower cervical spine. For a normal comparison view click HERE. CT showed retropharyngeal cellulitis without abscess. He was given ABX and decadron and admitted to the ICU. Next day was doing better with resolution of stridor. Scoped by ENT showing acute supraglottitis thought to be due to a primary upper aerodigestive tract infection and not infection of cervical hardware
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