Not All Acute Neck Swellings Are Hematomas: A Cervical Cyst Rupture After Minor Trauma

Acute lateral neck swelling is an uncommon but potentially high-risk presentation in the emergency department. When symptoms occur after minor trauma, cervical hematoma is often presumed. However, rupture of a preexisting cervical cyst may closely mimic hematoma in both clinical presentation and imaging, creating a potential diagnostic pitfall and increasing the risk of misinterpretation in the emergency setting.

A previously healthy 15-year-old male presented to the emergency department with acute right-sided neck swelling, pain, and restricted neck motion approximately 14 hours after a sudden neck-turning movement. Initial assessment revealed normal vital signs and laboratory findings. Bedside ultrasonography demonstrated a well-defined cystic lesion with dense internal content. Contrast-enhanced computed tomography revealed a solitary hypodense cervical cystic lesion extending from the right supraclavicular region into the right cervical compartment, without enhancing solid components or surrounding inflammatory change, consistent with acute cyst rupture. Bedside needle aspiration performed in the emergency department yielded approximately 50 mL of homogeneous, straw-colored, nonhemorrhagic fluid, resulting in rapid clinical improvement. The patient was discharged after a period of observation with close outpatient follow-up and experienced an uneventful recovery.

This case highlights an important diagnostic consideration in which acute neck swelling after minor trauma may represent rupture of a cervical cyst rather than traumatic hematoma. Continuous nursing assessment and effective physician-nurse collaboration are essential for airway monitoring, procedural support, safe patient disposition, and discharge education in uncommon but potentially high-risk emergency presentations.