A 13-year-old girl complained of a painful right ear lobe of three days duration. She tried to remove the ear ring and had to abandon the attempt when it started to bleed. Examination showed the right ear lobe was swollen and tender on palpation (Panel). The swelling was firm, with an area of hardness palpable in the centre. There was no pus or discharge from the swelling. On the posterior aspect of right ear lobule, there was a pointed golden needle pin noted (Panel). What is the diagnosis? Answer: refer to page 189

Answer: Embedded ear ring The patient was started on oral antibiotics and an analgesic. Her condition improved with treatment, with reduction of oedema and pain. The hard mass inside the earlobe, which was the gold ear ring, was palpable. The ear ring was removed under local anaesthesia and the wound healed well upon follow-up in the clinic.

A massive goiter may constrict the trachea resulting in shortness of breath. Recurrent laryngeal nerve compression may cause vocal cord paralysis. We highlight a case of a 62-year-old female with a 30 year history of an anterior neck swelling gradually increasing in size. She presented with acute symptoms of upper airway obstruction and voice changes. Emergency thyroidectomy was performed by dividing the middle part of the gland using ultrasonic scissors. The recovery was uneventful and the patient regained normal vocal cord function post operatively.

A neck mass with soft consistency suggests the diagnosis of a cyst which is usually congenital in origin. Needle aspiration yielding blood should alert the physician the possibility of hemangioma although it is very rare. Ultrasonography and computed tomography will delineate the extent and nature of the lesion and provide the roadmap for surgical excision. We report a case of a girl who presented with a painless neck mass which was later found to be a hemangioma originating from the sternohyoid muscle. The morphology and immunohistochemical stain were consistent with hemangioma.