A pain in the neck

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.

Abdominal ultrasonography showed a normal liver and gall …