A 44-year-old man presents to his local urgent care clinic for chest pain radiating up into his neck.  He states that the pain started 5 hours ago and is gradually getting worse.  The radiating chest pain is aggravated by breathing or swallowing. He denies any trouble breathing, fever, vomiting, cough, or any other complaints.


On physical examination, his vital signs are all normal, and his skin is warm and dry. His head and neck and heart and lung sounds are also normal, as is the rest of the physical exam.

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An electrocardiogram (EKG) is performed and shows no abnormalities.  A chest X-ray is also performed, and the radiologist determines that it is normal.  The healthcare provider gives the patient the good news and recommends that he go home and take ibuprofen for the pain, which should improve with time. The patient, however, states that the pain is actually getting worse, especially in his neck and when he swallows.

A soft-tissue lateral neck X-ray is ordered and performed.  The lateral view is shown below.

What are the findings on this X-ray?  What is the most likely diagnosis?

Click to the next page for the answer.