Welcome to the October PACE Case Challenge. First correct answer post wins this months Starbucks gift card! Winner will be announced live on our next Webcast.

See the case and reply below.


14 year female presents with 2 weeks of progressively worsening throat pain and fevers. Initially treated with Amoxicillin for suspected strep throat for 10 days. Multiple swabs negative for strep. Now presenting to the emergency department with acute onset increased work of breathing, tachypnea, and tachycardia. On examination patient appears flush and unwell, is febrile, has palpable pain to right side of neck, tachypnea, with good air entry bilaterally and no wheeze. SpO2 is 90% on room air prior to oxygen therapy. A lateral neck soft tissue x-ray is completed and does not show widening of the prevertebral spaces. Chest imaging was completed as depicted.

What is the diagnosis and management?