A 29-year-old man came to the emergency department with a 3-day history of progressively worsening sore throat, dysphagia, odynophagia (painon swallowing), and shortness of breath after unsuccessful treatment for Streptococcus pharyngitis. He reported having fevers and chills at home, and he had not slept the past 2 nights for fear that his “airway was closing.” He had tachycardia and tachypnea at presentation.
Physical examination was significant for an erythematous posterior oropharynx without tonsillar enlargement or exudates. The white blood cell count was 29,300 cells/mm3, with 92.6% neutrophils and 89% bands. A lateral soft-tissue x-ray of the neck was obtained (FIGURE 1), and compared with a cervical spine x-ray view taken the year before (FIGURE 2).
FIGURE 1
Soft-tissue neck radiograph
FIGURE 2
The same patient a year before
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How should the diagnosis be confirmed?
How should the patient be treated?