Presentation
Right sided neck and retrosternal pain with fevers and raised inflammatory markers. Four weeks post dental work
Patient Data
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There is a soft tissue mass posterior to the manubrium and adjacent to both sternoclavicular joints. This appears to also interface with the right first rib costomanubrial junction, although no bone destruction. There is surrounding fat stranding and prominent lymph nodes in the right lower retrotracheal and hila areas.
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There is a thick walled collection in the right lower neck. This appears to be anterior to (without infiltration into) the thyroid gland and extends into the upper mediastinum posterior to the right sternoclavicular joint. There is a 13 x 26 x 25 mm liquefied component. Surrounding granulation tissue is seen extending into the superior mediastinum in the pretracheal region and right carotid space. Sternoclavicular joints appear unremarkable. There are no features of osteomyelitis or disciitis in the cervical or upper thoracic spine.
Case Discussion
The patient had a Staphylococcus aureus bacteremia on multiple blood cultures. A decision was made not to drain the collection and he was treated with long-term IV antibitoics.
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