An infant with fever and drooling: Infection or trauma?

We present the case of an 11-month-old infant who presented to the emergency department (ED) with drooling, fever, and minimal inspiratory stridor. Radiographs of the neck were obtained, which revealed extensive subcutaneous emphysema of the neck and air in the retropharyngeal space. Laryngoscopic evaluation revealed a 5-mm laceration in her posterior hypopharynx. The child was later found to have two unexplained fractures in different stages of healing suggestive of previous nonaccidental trauma. The purpose of this report is to review the differential diagnosis and evaluation of the child with fever and drooling, and to raise the awareness of physicians evaluating children with uncommon presentations that child abuse can present in the most unusual ways.