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Peer Reviewed

Radiology Quiz

What Is Causing This Young Man’s Sore Throat?

Volume 61 - Issue 11 - November 2021

  • AUTHORS:
    Gemma L. Pansch, DO • David S. Bullard, MD, MEd

    AFFILIATIONS:
    Department of Emergency Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio

    CITATION:
    Pansch GL, Bullard DS. What is causing this young man’s sore throat? Consultant. 2021;61(11):e17-e18. doi:10.25270/con.2021.03.00020

    Received November 18, 2020. Accepted January 6, 2021. Published online March 29, 2021.

    DISCLOSURES:
    The authors report no relevant financial relationships.

    CORRESPONDENCE:
    David S. Bullard, MD, MEd, MetroHealth Medical Center, Department of Emergency Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109 (dbullard@metrohealth.org)

     

    A 22-year-old man presented to the emergency department with a sore throat. His pain began 12 hours earlier on the left side and subsequently progressed to the right side. After obtaining his history and conducting a physical examination, the patient mentioned anecdotally that he has had right elbow swelling for the past 6 weeks after playing basketball.

    The patient was afebrile with stable vital signs. His oropharynx was negative for erythema or exudates. Submandibular fullness was appreciated, and the floor of the mouth had swelling and ecchymoses. He had a “hot potato” voice. Additionally, his right elbow was swollen and diffusely tender.

    As the physician was exiting the examination room, the patient mentioned that he recently moved from out of state, has hemophilia, and had not received factor VIII replacement for the past month. He did not know his native factor level but was supposed to infuse factor VIII 3 times per week.

    Due to the soft tissue swelling, his abnormal voice, and history of hemophilia, a computed tomography scan of his neck was conducted (Figure).

    Figure 1 sore throat in a young man

     

     

    Answer and discussion on next page.

     

References

1. Hoots WK. Emergency care issues in hemophilia. World Federation of Hemophilia. Published online November 2007. http://www1.wfh.org/publication/files/pdf-1196.pdf  

2. Bogdan CJ, Strauss M, Ratnoff OD. Airway obstruction in hemophilia (factor VIII deficiency): a 28‐year institutional review. Laryngoscope. 1994;104(7):789-794. https://doi.org/10.1288/00005537-199407000-00002

3. White 2nd GC, Rosendaal F, Aledort LM, Lusher JM, Rothschild C, Ingerslev J; Factor VIII and Factor IX Subcommittee. Definitions in hemophilia. Recommendation of the scientific subcommittee on factor VIII and factor IX of the scientific and standardization committee of the International Society on Thrombosis and Haemostasis. Thromb Haemost. 2001;85(3):560. doi:10.1055/s-0037-1615621

4. Tebo C, Gibson C, Mazer-Amirshahi M. Hemophilia and von Willebrand disease: a review of emergency department management. J Emerg Med. 2020;58(5):756-766. https://doi.org/10.1016/j.jemermed.2020.02.019

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6. Furie B, Limentani SA, Rosenfield CG. A practical guide to the evaluation and treatment of hemophilia. Blood. 1994;84(1):3-9. https://doi.org/10.1182/blood.V84.1.3.3

7. Bhatnagar N, Hall GW. Major bleeding disorders: diagnosis, classification, management and recent developments in haemophilia. Arch Dis Child. 2018;103(5):509-513. https://doi.org/10.1136/archdischild-2016-311018