Intended for healthcare professionals

Endgames Case Review

A pain in the neck

BMJ 2019; 367 doi: (Published 21 November 2019) Cite this as: BMJ 2019;367:l6008
  1. Farzahna Mohamed, consultant endocrinologist,
  2. Frederick Raal, professor and head, division of endocrinology
  1. Division of Endocrinology and Metabolism, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  1. Correspondence to F Mohamed farzahna.mohamed{at}

A 39 year old woman presented with a one week history of progressive swelling and pain on the right side of her neck that was aggravated by eating. She had no relevant dental history. She was apyrexial and physical examination revealed a swelling of the right submandibular region extending to the angle of the mandible posteriorly. The swelling was firm in consistency and tender on palpation. The woman’s blood test results are shown in table 1.

View this table:
Table 1

Results of relevant blood investigations

Abdominal ultrasonography showed a normal liver and gall …

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