Case #32: The man with a neck swelling


This 64-year-old man presented with one week history of rapidly progressive swelling on the left side of his neck. There was no history of fever, chronic cough or weight loss. His appetite is diminished somewhat but otherwise he has no other complaints. He has no known medical illnesses but was a chronic smoker who stopped a few years ago. On examination, the swelling on his neck is about 4×4 cm in size, non-tender, hard in consistency, has a smooth surface, regular margin, not adherent to the skin, mobile from side-to-side but less mobile when moved vertically.

These are the picture of his neck and his CXR, respectively.

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Questions:

1. Interpret the CXR.
2. What is the most likely diagnosis?
3. How will you manage this patient?

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