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Retropharyngeal soft-tissue swelling in an elderly man.

History One week prior to hospitalization, a 78-year-old man experienced the insidious onset of anterior neck pain, sore throat, dysphagia, hoarseness, headache, and scalp pain. Generalized weakness, confusion, and an unsteady gait prompted his presentation. Prednisone (20 mg daily) had been prescribed three months earlier for refractory anemia without excessive normoblasts. Physical examination on admission revealed a diaphoretic, toxic-appearing elderly man with a temperature of 39.6 °C, a pulse rate of 128 beats per minute, a respiratory rate of 34/min, and a blood pressure of 136/86 mm Hg. The patient resisted passive flexion of the neck. The thyroid gland was asymmetrically enlarged, with predominance of the right lobe, and was nonfluctuant and exquisitely tender. The teeth were severely carious. Hyperdynamic circulation and an apical systolic heart murmur were present. The patient had no splenomegaly or palpable lymphadenopathy. The remainder of the results of the physical examination were normal. The findings