A 46-year-old woman presented at the emergency department with progressive swelling of the neck, acute dysphagia, altered voice and retrosternal pain after choking that morning. While swallowing muesli she felt a sharp pain in her throat, followed by some mild coughing. Her medical history was not contributory, but one of her sisters had died of esophageal carcinoma. Direct flexible laryngoscopy by the otorhinolaryngologist did not show abnormalities, particularly supraglottic swelling or a foreign body. Preventive endotracheal inubation was performed because of a threatened airway. CT scan of the neck and chest identified diffuse subcutaneous emphysema, and extensive pneumomediastinum, as shown in figure 1. No injuries of the esophagus or trachea were noticed on the CT scan: no pneumothorax, free intra-abdominal gas or foreign body.
WHAT IS YOUR DIAGNOSIS? See page 303 for the answer to this photo quiz.