Case 3: Rapidly Expanding Neck Mass Leading to Cardiopulmonary Arrest in a 14-year-old Boy

1. Stanley Lee, MD* 2. Ahmed Aly, MBBS* 3. Paayal Bhakta, MD* 4. Karthikeyan Parameswaran, MBBS* 5. Valeriy Chorny, MD* 6. Rohit Pinto, MD* 7. Jianying Zeng, MD† 8. Richard Hong, MD‡ 9. Melvyn Braiman, MD* 1. *Department of Pediatrics, 2. †Department of Pathology, and 3. ‡Department of Radiology, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY A 14-year-old boy is transferred from an outside hospital with a 1-day history of severe left upper neck swelling and pain without any known precipitating factors. Three years ago the patient had a similar episode: a painful left neck mass was diagnosed as lymphadenitis and treated with amoxicillin without sequelae. In the emergency department, vital signs and a complete blood count are within normal limits. The mass is soft and tender to palpation, measuring 1.0 × 1.5 cm. A computed tomographic (CT) scan with contrast reveals an expansile lesion stemming from the left aspect of the hyoid bone compressing the trachea (Fig 1). The ENT team performs a bedside laryngoscopy and confirms a rightward tracheal deviation and compression. Figure 1. Expansile lesion of the hyoid bone causing a rightward tracheal deviation. A computed tomographic scan of the neck revealing a 1.3-cm lesion from the left hyoid bone (blue arrow) with an associated 11.2-cm soft tissue mass expanding through the thoracic outlet. The lesion led to a rightward tracheal deviation and compression (red arrow). On admission to the inpatient unit, the patient is alert, oriented, and in mild distress due to pain, but his vital signs remain within normal limits. The neck mass remains very tender to palpation and has expanded to 4.0 × 5.0 cm on physical examination, a few hours after the initial measurement. His neck has limited movement, and there are no signs of respiratory distress, stridor, drooling, or retractions. He is able to speak in full sentences. He has some difficulty in swallowing solids but is tolerating liquids. He is started on …