A 23-month-old female sustained a trip-and-fall with a pencil in her mouth. There were no initial signs of bleeding, the pencil was intact, and child was acting appropriately.

The parents brought the child into the emergency department 6 hours later as she woke up crying in pain. It was noted that her cry sounds different and is best described as inspiratory stridor as seen in croup. Axial computed tomographic images of the neck reveal prevertebral swelling from a puncture likely resulting in abscess/hematoma. There was no involvement of the internal carotid artery.


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