‘The catcher in the rye’ – a case report of a swallowed grain and a peculiar neck abscess

Abstract Inhalation or swallowing of foreign bodies (FBs) are relatively common in the pediatric population, with a male predominance. Obtaining relevant clinical history, in these situations, may be a challenge, due to the fact that young children cannot give a detailed account of what happened and in some cases an adult caretaker may not have been present. In order to complicate even further, many aspirated or swallowed FBs in children tend to be small and radiolucent, making the radiological diagnosis even more challenging. A 16-year-old healthy male presented to the emergency room with the chief complaint of a swollen mass in the left midjugular area of his neck, off-midline. He recalled, that 3 months prior to the incident, he accidentally swallowed a grain of wheat while picking his teeth. One month later, he started complaining of intermittent dysphagia as well as localized edema and erythema in his neck, without pyrexia. Two months later, a neck ultrasound demonstrated a 7 mm hyper echogenic linear mass in a small fluid collection. A contrast enhanced computed tomographic (CT) scan of the soft tissues of the neck revealed an abscess measuring 0.8*2.36*2.0 cm, superficial to the sternocleidomastoid (SCM) muscle. Due to the fact that a superficial collection was diagnosed, the patient underwent incision and drainage during which a splinter of a grain of wheat, measuring 1 cm in length, was surgically extracted. In cases of localized neck masses, FBs should be considered as a possible cause, especially in children.