Unilateral Anterior Neck Discomfort in Active Young Adult

Case at a Glance

A 29-year-old male presents with intermittent right-sided anterior neck discomfort, previously diagnosed with gastroesophageal reflux disease, seeking evaluation for persistent symptoms despite treatment.

Patient's Story

The patient is a 29-year-old male (height 5'9", weight 170 lbs) who reports experiencing intermittent discomfort in the right anterior neck region. He describes the sensation as pressure-like, localized to a specific area that feels connected to structures near his thyroid cartilage (Adam's apple). The discomfort is positional, becoming more noticeable when lying down or during solitude. He reports occasional sharp, pinching sensations, particularly during physical exercise including sit-ups and hip thrust movements. The patient has been actively exercising for the past year and wonders if muscle imbalance might be contributing. Symptoms occasionally worsen after consuming dairy products.

Initial Assessment

The patient had previously consulted with his primary care physician who performed a physical examination and reported no palpable abnormalities. Subsequently, an ENT specialist evaluated the patient and diagnosed severe gastroesophageal reflux disease (GERD). The patient was started on pantoprazole therapy. Despite this treatment, the patient continues to experience localized neck discomfort and is concerned about other potential underlying conditions.

The Diagnostic Journey

Physical examination by multiple physicians revealed no palpable masses or asymmetrical structures in the neck region. The patient notes that bilateral palpation reveals similar anatomical structures, though the symptomatic right side feels more prominent. ENT evaluation focused on acid reflux as the primary etiology. The patient provided photographic documentation showing neck positioning during swallowing and mild neck strain, though these were taken during active maneuvers rather than at rest.

Final Diagnosis

Primary diagnosis: Gastroesophageal reflux disease with possible laryngopharyngeal reflux. Differential considerations include exercise-induced muscle strain, cervical muscle imbalance, or referred pain from GERD.

Treatment Plan

Continuation of proton pump inhibitor therapy (pantoprazole) as prescribed by ENT specialist. Patient education regarding GERD dietary modifications, particularly regarding dairy intake. Consideration of physical therapy evaluation for potential exercise-related muscle imbalance. The patient is questioning whether additional imaging studies such as X-rays would be beneficial for further evaluation.

Outcome and Follow-up

Patient remains symptomatic despite acid suppression therapy and is seeking guidance on whether to pursue additional diagnostic imaging. Symptoms continue to be exercise-related and positionally dependent. Close monitoring and potential reassessment with ENT or primary care physician may be warranted if symptoms persist or worsen.