Swollen neck and crepitus after bouts of cough

Abstract

A 68-year-old Malay man, a chronic smoker with underlying chronic obstructive airway disease (COAD), hypertension, diabetes mellitus and history of pulmonary tuberculosis (more than 30 years ago), complained of sudden onset of neck swelling after he had bouts of cough in the morning. It was associated with difficulty in breathing and a change in voice. The swelling was increasing in size with each successive coughing episode. He admitted having a mild non-productive cough 1 week prior to presentation. On examination, the neck swelling extended superiorly to the cheek and inferiorly to the upper chest wall. Palpation at the swollen area revealed the presence of crepitus. A chest radiograph was performed (Figure 1).

Keywords

• Mediastinal emphysema
• chronic obstructive airway disease
• pulmonary tuberculosis
• smoking