PMC6642750_01
Clinical photograph demonstrating the left-sided submandibular swelling.
CRIOT2019-2712481.001.jpg
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fig1
A postoperative seroma was thought to be the most likely cause of the swelling (Figure 1).
Coronal reformats of the axial CT of the skull base and neck demonstrating extensive subcutaneous emphysema within the left submandibular, submental, parotid, and parapharyngeal spaces.
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fig2
To our surprise, this demonstrated a sizeable air-filled cavity in the left submandibular and submental areas of the neck with associated subcutaneous emphysema within the left parotid and parapharyngeal spaces (Figure 2).
(a) Axial postcontrast CT at the level of the fossa of Rosenmuller demonstrating the site of perforation through the left nasopharynx (arrow). (b) Axial postcontrast CT below the level of the fossa of Rosenmuller demonstrating air tracking through the left parapharyngeal space (arrow) and around the deep and superficial parotid lobes.
CRIOT2019-2712481.003.jpg
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fig3
An air leak arising from the left nasopharynx, just inferior to the Eustachian tube opening, was identified (Figure 3).