Summary

While paint-balling a 15-year-old boy was shot on the front of his face guard causing him to hyperextend his neck. Over the next few days he developed neck stiffness and a large painful swelling over his upper left sternocleidomastoid muscle. CT confirmed this to be a haematoma abscess and at operation it was found to originate from the parapharyngeal vessels, extending from the skull base and tracking inferiorly along the carotid sheath, compressing (and partially thrombosing) the internal jugular vein (IJV). After surgical decompression, double-dose low molecular weight heparin and antibiotics, the patient made an uneventful recovery, including recanalisation of his IJV. Delayed cervical haematoma can result in neck space infection and potential airway compromise. Early CT scanning optimises timely intervention, consisting of airway protection, broad-spectrum antibiotics and surgical drainage.