An unusual cause of pain in the neck.

Accepted 4 March 1997 A 76-year-old woman presented to her general practitioner with pain in the throat and neck, worse on coughing and associated with swelling. Twenty-four hours earlier she had undergone flexible sigmoidoscopy and laser treatment with Nd:YAG laser for a sessile tubulovillous adenoma of the rectum. She had undergone laser treatment uneventfully three times before at four-weekly intervals and the tumour had regressed macroscopically almost completely. There was no abdominal pain, vomiting or bleeding per rectum. The abdomen was soft, non-tender and the bowel sounds were normal. There was diffuse swelling of the neck with crepitus. A plain Xray of the abdomen (figure 1) and an erect chest X-ray (figure 2) were done: