Fractured thyroid cartilage symbolizing hidden neck trauma leading to mediastinitis.

Silent Strangulation: When a Neck Trauma Unveils a Hidden Danger

Nico Varela in Health & Wellness December 2025 • 4 min read.

"A case study reveals how a seemingly minor neck injury can lead to a life-threatening mediastinitis, highlighting the importance of thorough investigation and awareness."

Imagine a scenario where a seemingly minor injury spirals into a life-threatening condition. This is precisely what happened in a recent forensic case involving a 51-year-old woman. What began as complaints of an earache and difficulty swallowing quickly escalated into a battle against mediastinitis, a severe inflammation of the chest cavity. The root cause? An undetected neck trauma, stemming from a manual strangulation attempt, that fractured her thyroid cartilage.

Mediastinitis, while often linked to esophageal perforations or complications from cardiothoracic surgery, can also arise from less obvious sources. Infections spreading from adjacent tissues or, as in this tragic case, a compromised airway, can trigger this dangerous condition. The challenge lies in the fact that the initial symptoms can be misleading, potentially delaying accurate diagnosis and treatment.

This article delves into the details of this compelling case, drawing from a forensic science report to shed light on the diagnostic hurdles, the critical role of a comprehensive medical history, and the potentially devastating consequences of overlooking subtle signs of trauma. It's a reminder that sometimes, the most dangerous threats are the ones we don't see coming.

How Did a Neck Trauma Lead to a Chest Infection?

Fractured thyroid cartilage symbolizing hidden neck trauma leading to mediastinitis.

The victim initially presented with symptoms that appeared to point towards a common infection: earache, angina, and difficulty swallowing. A doctor noted right tonsillar hypertrophy and a hyperemic right tympanum. Initial blood work revealed elevated white blood cell counts, a sign of infection. Sadly, after being discharged with a diagnosis of tonsillitis and prescribed antibiotics and cortisone, her condition worsened rapidly.

Over the next 24 hours, more alarming symptoms surfaced, including a fever. She was admitted to another emergency department. Mild pain on palpation of the neck and edema of the right tonsil and false vocal cords were observed. Lab results confirmed elevated white blood cell counts. The medical team continued treatment with cortisone and pain relievers, but she rejected medical care and was discharged.

Persistent cough and back pain emerged.
Laryngoscopy revealed no intralaryngeal trauma.
A chest CT scan unveiled air in the posterior mediastinum, extending from the middle esophagus to the upper neck, along with right pleural effusion. Abnormal tissue behind the larynx and a fluid collection in the mediastinum were also detected.

Initially, doctors suspected an esophageal perforation and performed an esophagogastroduodenoscopy, but no injuries were found. A chest tube was inserted, draining approximately 400 mL of foul-smelling liquid. The patient's condition continued to deteriorate. She experienced hypoxemic respiratory failure, oliguria, lactic acidosis, and metabolic acidosis, requiring intensive care. She was later treated with continuous veno-venous hemodiafiltration (CVVHD). A subsequent CT scan revealed a loculated fluid collection with thickened, hypervascularized edges in the lower right parapharyngeal and paralaryngeal space. Despite a tooth extraction and fasciotomy of the sternocleidomastoid muscle, the patient was pronounced dead. The initial diagnosis was septic shock of unknown origin, with a suspected odontogenic abscess.

Lessons Learned: The Importance of a Complete History

This tragic case underscores the critical need for a thorough medical history and a high index of suspicion when dealing with potential trauma. While thyroid cartilage fractures are often associated with hangings, they can also occur in milder neck traumas like manual strangulation attempts. The subtle symptoms, combined with a lack of initial suspicion, can easily lead to a delayed or missed diagnosis. By recognizing the potential for seemingly minor injuries to have severe consequences, medical professionals can improve patient outcomes and ensure that justice is served in cases of foul play.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1111/1556-4029.13957, Alternate LINK

Title: A Fatal Mediastinitis Due To A Neck Trauma From An Undeclared Assault

Subject: Genetics

Journal: Journal of Forensic Sciences

Publisher: Wiley

Authors: Fidelia Cascini, Domenico Biondo, Carolina Giannace, Laura Filograna, Domenico Laino, Arnaldo Capelli, Vincenzo L. Pascali

Published: 2018-11-16

Everything You Need To Know

What is mediastinitis, and why is it a life-threatening condition?

Mediastinitis is a severe inflammation of the mediastinum, the space in the chest that contains the heart, major blood vessels, trachea, and esophagus. It's life-threatening because the infection can quickly spread to vital organs. Infections can stem from esophageal perforations, complications from cardiothoracic surgery, or, as shown in this case, from infections spreading from adjacent tissues or a compromised airway. The rapid progression of mediastinitis can lead to septic shock, organ failure, and death if not promptly treated.

What were the initial symptoms that led to the misdiagnosis in the case of the 51-year-old woman?

The initial symptoms were an earache, difficulty swallowing (dysphagia), and a sore throat, along with findings such as right tonsillar hypertrophy and a hyperemic right tympanum. The patient was initially diagnosed with tonsillitis. These symptoms, while common to less serious conditions, masked the underlying neck trauma that was the root cause of the subsequent mediastinitis. The subtle presentation of the injury, without a clear history of trauma, made the diagnosis challenging.

How can a seemingly minor neck trauma, such as that from a manual strangulation attempt, lead to such a severe condition like mediastinitis?

A manual strangulation attempt can fracture the thyroid cartilage. This fracture, even if seemingly minor, can compromise the airway and allow bacteria to enter the surrounding tissues. This breach in the body's defenses can lead to infection, which, if left untreated, can spread to the mediastinum, causing mediastinitis. The infection can then disseminate throughout the chest cavity. This cascade of events highlights the importance of recognizing that what appears to be a superficial injury can have profound and deadly consequences.

What diagnostic challenges were faced in this case, and what specific findings eventually led to the correct diagnosis?

The initial diagnostic challenges included misleading symptoms, which pointed toward a common infection. The initial investigations, including blood work and a physical examination, did not immediately reveal the underlying neck trauma. Later, the patient's condition worsened with the appearance of new symptoms. The chest CT scan was crucial, revealing air in the posterior mediastinum and a fluid collection. An esophagogastroduodenoscopy was performed to rule out esophageal perforation, and it was followed by a chest tube insertion. A subsequent CT scan revealed a loculated fluid collection with thickened, hypervascularized edges. Despite these interventions, the patient's condition continued to deteriorate. The complete picture of the mediastinitis evolved gradually as the severity of the inflammation increased.

Why is a complete medical history crucial in cases of neck trauma, and what are the implications of overlooking subtle signs?

A thorough medical history is crucial because it can reveal a history of a trauma which may not be initially obvious, such as a manual strangulation attempt. Without this context, subtle symptoms like difficulty swallowing or neck pain might be misinterpreted. Overlooking these signs can lead to delayed diagnosis and treatment, as was the case here. This delay allows the infection to spread and worsen, potentially leading to life-threatening complications like mediastinitis, septic shock, and even death. A comprehensive history allows doctors to investigate the underlying cause of symptoms, potentially saving lives and ensuring that cases of foul play are properly addressed.