Case 3: A 17-year-old Boy with 6 Weeks of Left Neck Swelling

Abdullah Almaghraby; Mattia Chason; Maureen Banigan

doi:10.1542/pir.2017-0081

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Download PDF

Abdullah Almaghraby, MD*
Mattia Chason, MD, MS^†
Maureen Banigan, MD*

^*Children's National Health System, Washington, DC
^†Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, MD

AUTHOR DISCLOSURE
Drs Almaghraby, Chason, and Banigan have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 17-year-old boy with a history of autism spectrum disorder, small lymphatic malformation on the scalp, and scoliosis presents to the emergency department with a 6-week history of left lower neck swelling. He was initially evaluated by his primary care physician and completed a 10-day course of clindamycin for presumed lymphangitis. The swelling initially improved, but within a few days of stopping clindamycin, the swelling worsened again. He was restarted on clindamycin, and given the recurrence of symptoms, a computed tomographic scan of the neck and chest was obtained (Fig 1). Findings showed a large, nonenhancing, low-density mass extending from the left neck down into the superior mediastinum and left upper thorax with mild rightward displacement of cervical and mediastinal structures and encasement of the left subclavian artery. No airway compression or narrowing was noted. He was transferred to our institution for further evaluation with concern for …