Airway obstruction Quiz: Ace Your Exams

A 51-year-old man comes to the emergency department with a 2-day history of progressive sore throat, dysphagia, and dyspnea. He has not been able to eat or drink due to severe pain. He reports a fever of 38.7°C (101.7°F). His medical history is significant for poorly controlled type 2 diabetes mellitus, and a 25-pack-year smoking history. Temperature is 39.2°C (102.6°F), blood pressure is 103/69 mmHg, pulse is 112/min, respiratory rate is 26/min, and oxygen saturation is 92% on room air. On physical examination, he appears uncomfortable and is leaning forward with his hands on his knees, drooling, and speaking in a muffled voice. His neck appears swollen and is diffusely tender, and he is holding it in a flexed position. He has diffuse pharyngeal erythema on oropharyngeal exam, and no tongue deviation. The lateral neck x-ray is shown below. Which of the following is the most likely diagnosis?
 
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