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(CHEST 2003; 124:1533-1534)
A 40-year-old woman is recovering from a tricyclic antidepressant overdose and is about to be transferred out of the ICU. She complains of sore throat, dysphagia, stiffness in back of the neck, and dyspnea. Even though she required endotracheal intubation and mechanical ventilation during treatment and the intubation had been difficult, she was successfully extubated 48 h before without any respiratory complaints. Temperature is 39[degrees]C, BP is 150/88 mm Hg, pulse rate is 98 beats/min, and respirations are 22 breaths/min. With the exception of bilateral coarse breath sounds and neck stiffness, the rest of the physical examination is unremarkable. Kernig and Brudzinski signs are absent. Which of the following studies should be done next?
A. Lumbar puncture
B. Head CT scan with contrast
C. Sinus CT scan
D. Blood cultures
E. Lateral neck radiograph
Answer: E. Lateral neck radiograph.
Because the patient has a retropharyngeal abscess secondary to trauma during endotracheal intubation, a lateral neck radiograph should be done next. While lower cuts of sinus and head CT scans might fortuitously pick up the abnormality, the lateral neck radiograph is most likely to lead to the correct diagnosis. Clues to this diagnosis were the history of a...