We present a case of a 69 year old female with a spontaneous, diffuse, painful, swollen and bruised anterior neck. She also had concurrent use of a direct oral anticoagulant (DOAC), apixaban. We discuss the investigation and management of a spontaneous neck haematoma, as well as the management dilemmas with DOACs and severe bleeding.

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This is a clinical photograph showing a standard transverse cervical collar incision which appears to be halfway between the suprasternal notch and cricoid cartilage. The incision is approximately 5-6 centimetres in length and is usually performed during thyroid surgery or 4-gland exploration for parathyroid disease. It appears that tissue glue has been applied for skin closure and a surgical drain can be seen emerging below the incision. The presence of a drain suggests that the patient may have had a total thyroidectomy as there is a move away from using drains for a standard diagnostic hemithyroidectomy.

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This is a clinical photograph of a young boy drooling/dribbling (saliva incontinence). He also appears to be breathing with mouth open at rest and his tongue appears slightly large. If this is true macroglossia, it may be associated with an underlying syndrome such as Down’s. There is also evidence of nasal discharge and excoriation around oral cavity.

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This is a clinical photograph showing an adult male with a 3-4 cm right submandibular swelling. There is no overlying erythema or skin changes.

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A 55 year old male presents with a 3 month history of an anterior neck lump. What does the image show?

This is a clinical photograph of an adult male with an anterior neck swelling, consistent with a thyroid goitre. The differential diagnosis includes lymphadenopathy, a branchial cleft anomaly or a dermoid cyst.

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