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Trachea

Trachea

The trachea, commonly known as the windpipe, is a vital part of the human respiratory system. It serves as a passageway for air to travel between the larynx and the bronchi, allowing oxygen to reach the lungs. Let's explore its anatomical features, dimensions, layers of the tracheal wall, associated muscles, and the functions of its parts.
Anatomical Features:
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Cervical Necrotizing Fasciitis With Intractable Hiccups.

Eduardo Lorenzo¹, Parikshit Chapagain¹, Swotantra Gautam²

¹Internal Medicine, AdventHealth Orlando, Orlando, USA.

|August 18, 2025

Summary

This case highlights intractable hiccups as an unusual symptom of cervical necrotizing fasciitis (CNF) in an immunosuppressed patient. Early imaging and multidisciplinary care are crucial for diagnosing and treating this severe infection.

Keywords:

cervical necrotizing fasciitis immunocompromised intractable hiccups misdiagnosis neck mass necrotizing fasciitis rheumatoid arthritis sepsis

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Area of Science:

Infectious Diseases
Immunology
Radiology

Background:

Cervical necrotizing fasciitis (CNF) is a rare, life-threatening soft tissue infection.
Immunosuppression, particularly from medications like etanercept, can mask typical signs of infection.
Rheumatoid arthritis patients on immunosuppressants are at increased risk for severe infections.

Observation:

A 61-year-old immunosuppressed male with rheumatoid arthritis presented with intractable hiccups, a previously unreported symptom of CNF.
Initial diagnosis of viral syndrome was complicated by the absence of skin changes due to etanercept.
The patient developed severe sepsis with neck swelling, dysphagia, and ligneous induration.

Findings:

Contrast-enhanced computed tomography (CT) scan revealed CNF with descending necrotizing mediastinitis (DNM).
Gas was present in the cervical and mediastinal soft tissues, confirming the extent of infection.
Prompt surgical debridement and broad-spectrum antibiotics (linezolid, ampicillin-sulbactam) led to a favorable outcome.

Implications:

Hiccups may serve as an atypical presenting sign of CNF, potentially indicating phrenic/vagus nerve irritation or sepsis-induced hyponatremia.
This case underscores the importance of high clinical suspicion and early imaging in immunocompromised patients with atypical presentations.
New diagnostic strategies are needed to improve outcomes for this deadly condition.