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Neck/Mediastinal abscess

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Something new to add to your differential diagnosis of left shoulder pain....



54yo male presents to urgent care for 2 days of left shoulder pain after feeling a "pop" putting on his hunting coveralls.  Stable, no other history offered, no alarm s/s.  Worked up as musculoskeletal, sent home.   


Two days later presents to ER c/o of increasing shoulder pain.  Story he tells the ER is that that 5 days ago he pulled his own abscessed tooth out with vice grips and bled all over the bathroom.  He sprayed bleach to clean it up but fell, hitting his shoulder and caused him to breath in bleach fumes and now his shoulder hurts and he's coughing up phlegm with SOB.  Admitted for pneumonia.


I'm not sure what transpired in the 24 hours following... but day after admission gets a CT of his neck and thorax showing abscess formation within the inferior left neck extending into the superior mediastinum.  Urgently transferred for I&D and now in ICU. 


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