This week’s case highlights a case of an adolescent with neck swelling. All learners agreed that the first step was to obtain imaging. The choice of imaging largely depends on the clinician’s suspicion based on the history and physical examination. In this case, there was potential trauma to the neck which may increase the risk for a vascular injury like an aneurysm or dissection. In this situation, some made the case that a computed tomography angiography (CTA) was needed to rule out vascular injury. Others felt that given a reassuring exam, they could start with an ultrasound and obtain a CTA if the ultrasound was unrevealing.

Ultimately the patient received a CT chest and neck w/ contrast. The CT chest was unremarkable. The CT neck showed extensive lymphadenopathy and masses of the right neck extending from the C1 spinal level through to the supraclavicular nodes with mass effect on the adjacent vascular structures. The largest mass measures 4.1 x 3.2 x 3.2 cm.

The patient was admitted to Heme/Onc for tissue biopsy, which revealed classic Hodgkin lymphoma, nodular sclerosis type. He is currently undergoing treatment.