A Diagnostic Dilemma of Prevertebral Abscess Versus Food Bolus on Lateral Neck X-Ray: A Case Report

TL;DR

A 76-year-old woman's neck X-ray suggested a prevertebral abscess, but further tests revealed a food bolus, highlighting the importance of combining multiple diagnostic methods.

Contribution

This case report highlights the diagnostic challenge of distinguishing prevertebral abscess from food bolus using lateral neck X-ray findings.

Findings

A lateral neck X-ray showed prevertebral widening and radiolucency, initially suggesting a prevertebral abscess.

Endoscopy revealed and removed a food bolus, resolving the patient's symptoms.

Combining multiple investigations prevented misdiagnosis and inappropriate treatment.

Abstract

In this case, a 76-year-old female presenting with globus sensation post-oral intake demonstrated radiographical evidence of mottled radiolucency and prevertebral widening on a lateral neck X-ray at the inferior C4/cricoid cartilage, leading to concern for a prevertebral abscess. A decision was made to proceed with an urgent gastrointestinal endoscopy, and a food bolus was identified and removed, leading to a full remission of the patients’ symptoms. In this case, an appropriate diagnosis was achieved by combining multiple investigations, which highlights to clinicians that taking investigations in isolation, with the aforementioned lateral neck X-ray being the primary example, could lead to potential misdiagnosis and mismanagement of patients.

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