What should I do about my difficulty swallowing and chest pain after a recent neck and chest injury, given my history of sternum and spinal fractures, and previous pneumothorax?

Immediate Emergency Evaluation Required

You need to go to the emergency department immediately for evaluation of potential re-injury to your chest and neck structures, particularly given your history of sternum fracture, spinal fractures (T1, T2, C3), and previous pneumothorax. 1

Why This Is Urgent

Your symptoms of difficulty swallowing combined with chest pain after direct trauma to the neck and chest are concerning for several potentially serious injuries:

• Recurrent pneumothorax: Your history of bilateral lung collapse makes you at higher risk for recurrence after chest trauma. Progressive dyspnea and chest pain are classic symptoms that require immediate evaluation. 1

• Esophageal injury: Severe pain with swallowing (dysphagia) after neck trauma can indicate esophageal damage, which can cause mediastinal emphysema and is a surgical emergency if not addressed promptly. 1

• Tracheal or laryngeal injury: Direct neck trauma can cause airway injuries that may worsen over hours, potentially compromising your breathing. 1

• Vascular injury: Blunt neck trauma can cause vertebral artery dissection, which typically presents 12-24 hours after injury and can lead to devastating neurologic complications. Any neck pain after trauma requires prompt diagnostic assessment. 1

• Sternal re-fracture: Given your previous sternum fracture, re-injury is possible and can be associated with underlying cardiac contusion or great vessel injury. 1

What Will Happen at the Emergency Department

The emergency team will perform a structured evaluation prioritizing life-threatening injuries:

• Initial assessment: Chest X-ray and pelvic X-ray are standard for trauma evaluation, along with focused ultrasound (FAST exam) to detect fluid collections or pneumothorax. 2, 3

• CT imaging with IV contrast: This is the cornerstone examination for evaluating chest trauma in stable patients. CT chest with contrast will definitively assess for pneumothorax, hemothorax, vascular injuries, and esophageal injury. 1

• Neck imaging: CT angiography (CTA) of the neck is the first-line imaging for penetrating or blunt neck injuries in stable patients, with sensitivity of 90-100% for vascular injuries. 1

• Continuous monitoring: You'll be observed for signs of tension pneumothorax (progressive shortness of breath, decreased breath sounds) or airway compromise. 1

Critical Warning Signs

Seek immediate care if you develop any of these before reaching the hospital:

• Increasing difficulty breathing or shortness of breath
• Worsening chest pain
• Inability to swallow saliva
• Voice changes or difficulty speaking
• Coughing up blood
• Feeling faint or dizzy
• Rapid heart rate
• Neck swelling or bruising

1

Pain Management While Awaiting Care

If you must wait briefly before transport:

• Avoid lying flat: Sit upright or semi-reclined to ease breathing. 1
• Do not eat or drink: You may need procedures or surgery, and aspiration risk is increased with potential esophageal injury. 1
• Avoid taking pain medications on your own: This could mask worsening symptoms that doctors need to assess. 1

Common Pitfall to Avoid

Do not assume your symptoms will resolve on their own because your previous injuries healed well. Delayed presentation of serious injuries like esophageal perforation, pneumothorax, or vascular dissection can lead to life-threatening complications including mediastinitis, tension pneumothorax, or stroke. 1 The fact that you had previous severe chest trauma actually increases your risk for complications from re-injury, not decreases it.

Transportation

Call 911 or have someone drive you immediately to the nearest emergency department. Do not drive yourself given the risk of sudden deterioration. 1