Doctor my throat is closing, I cannot swallow!

How would you initially manage this patient?

To further investigate the cause a CT Neck and Thorax with contrast is performed. After evaluating the images from the CT scan, what do you think is the most likely diagnosis?

Fig:1 CT Neck and Thorax with contrast Axial Plane View

Fig:2 CT Head Neck and Thorax with contrast Axial Plane View

Fig:3 CT Neck and Thorax with contrast Axial Plane View

Patient then becomes hypotensive with the following observations:

• HR 145
• RR 21
• BP 85/50
• Temp 38.9
• Sats 94% on oxygen sitting in upright posture

And his blood profile demonstrating the following:

• WCC 30
• Neutrophils 29
• CRP 336
• Urea 10
• Creatinine 241
• e GFR 28

What’s your next step?