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

摘要

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 a possible neoplastic process.