Odynophagia and neck pain after exercise

Description

A previously healthy, non-asthmatic, non-smoker, 16-year-old male came for medical attention because of odynophagia and pain located at anterior cervical area and upper retrosternal area, increasing with swallowing and deep breathing, that begun after physical exercise at gymnastic class. The adolescent also mentioned a felling of air bubbles running up and down that area. There was no history of local trauma. He referred stuffed nose and mild cough but no other respiratory complaints or fever. Physical examination was unremarkable, with normal auscultation and no alterations on cervical and thoracic examination. Lateral soft tissue neck X-ray revealed free air in retropharyngeal space (figure 1, arrows). Chest X-ray showed a small amount of air in the upper mediastinum. Blood count was normal, and C reactive protein was negative. Mycoplasma pneumoniae IgM was negative. The patient was treated with high concentration oxygen and oral analgesia. The next day, he...

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