Intended for healthcare professionals

Endgames Spot Diagnosis

Neck swelling and enlarged tonsils

BMJ 2019; 366 doi: (Published 25 July 2019) Cite this as: BMJ 2019;366:l4361
  1. Charn Gill, ear, nose, and throat registrar,
  2. Max Sallis Osborne, ear, nose, and throat registrar,
  3. Lisha McClelland, ear, nose, and throat consultant
  1. Queen Elizabeth Hospital Birmingham, Birmingham, UK
  1. Correspondence to charn.gill{at}

An 18 year old man presented with a seven day history of gradually worsening throat pain, malaise, vomiting, neck swelling, odynophagia, and pyrexia. He had no history of weight loss, foreign travel, or night sweats; no notable medical history; and he was not a smoker. Examination revealed bilateral tender swellings in the upper jugular node region that became more obvious on rotation of the neck. He spoke with …

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