The patient is intubated and a nasogastric tube has been placed. There is no evidence of a prior operative procedure on the neck viscera, vessels or spine. There is generalized soft-tissue edema and free air within the soft tissue is the neck as described in more detail below. It appears that the nasogastric tube deviates as if it has penetrated the left pharyngeal wall at the level of the oropharynx and may have reentered the pharynx or pharyngeal wall somewhere in the low hypopharynx or upper cervical esophagus. This is discussed in more detail subsequently.

There is no edema or other abnormalities arising from the nasopharynx or adjacent deep tissue spaces.  There is accumulation of secretions, secondary to the tubes that are present.

There is no edema or other abnormalities arising from the buccal space, masticator space, floor of the mouth, submandibular space, maxilla, mandible or the adjacent superficial fascia or subcutaneous fat and skin, as far as can be evaluated given the support material.

The parotid, submandibular and sublingual glands are normal.

There is prominent edema and soft tissue swelling throughout the oropharynx, most extensive in the lower tongue base region on the left. At that level the nasogastric tube deviates to the left and most likely perforates the lateral pharyngeal wall. There is some free air in the parapharyngeal space, more pronounced on the left side. In the presence of free air and the extensive soft-tissue edema a developing spreading abscess should be considered likely.

There is prominent edema and soft tissue swelling throughout the hypopharynx, in continuity with the findings described in the oropharynx, most extensive at the level of the hyoid.

At this level, the nasogastric tube appears to be located outside the normal course of the pharynx. More caudally, at the level of the thyroid cartilage, the NG tube also follows a course that is most likely outside the hypopharyngeal wall More caudally the NG tube follows again the course of the esophagus and might be inside or outside the lumen, possibly within the muscular wall.

There is edema and an extensive amount of gas within the adjacent parapharyngeal space, the visceral space and the visualized portions of the mediastinum.

The retropharyngeal spaces are slightly edematous but there is no obvious retropharyngeal abscess in the lower neck.

There is no edema or other abnormalities within in the prevertebral, paravertebral or epidural spaces.

The cervical lymph nodes are normal.

There are no significant vascular abnormalities.

The edema and an extensive amount of gas extend from the visceral space into the mediastinum raising the possibility that deep neck abscess has spread to the upper mediastinum.

The endotracheal tube balloon is over distended and positioned from the crico-tracheal junction to about the fourth tracheal ring. Gas and edema surround the trachea; so that tracheal mucosal necrosis cannot be excluded for a cause for these findings.