Author: Prasanth Ravinthiran / Editor: Sarah Edwards / Codes: CP1, RP1, SLO1, SuC15, SuP7 / Published: 10/08/2023

A 47-year-old man presents to the Emergency Department (ED) complaining of Epigastric discomfort since last 8 hours that is radiating to upper back which is preceded by three episodes of vomiting. He also tells you he is having a change in voice for few hours.

He denies any chest pain, speech or visual disturbances, hematemesis, syncope, breathing difficulty, or anything else out of the ordinary.

He has no other past medical history. He has undergone haemorrhoidectomy surgery two months before.

His initial observations are:

  • Heart rate – 92 beats per minute
  • Blood pressure – 120/90mmHg (right arm)
  • Respiratory rate – 16 per minute
  • SpO2 – 98% on air
  • Temperature – 99.6 F

On examination patient had diffuse neck swelling which extends to bilateral parotid region which had crackling sensation on palpation. Clinical examination is otherwise unremarkable.