Diagnostic dilemma: Man delays sneezing, punctures his trachea

An X-ray revealed that air pockets had formed under the skin of the man's neck, as indicated by the arrows above. (Image credit: BMJ Case Reports 2023)

Patient: 30-year-old male from the UK.

Symptoms: The patient presented to the emergency department with severe pain and swelling in the neck, which limited his mobility. He reported that the pain began immediately after he suppressed a sneeze by pinching his nose and closing his mouth at the same time. He was driving at the time and was experiencing hay fever symptoms when he tried to suppress the sneeze.

Although there were no problems with breathing, swallowing or speaking, doctors noticed a slight crackling sound when they initially examined his neck.

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