Introduction. We report this large neck mass, located behind the sternocleidomastoid (SCM) within the posterior cervical space and anterior to the prevertebral fascia. The mass is displacing the carotid sheath and its neurovascular contents medially. It extends almost the whole length of the SCM muscle all the way down to the lung apex. Case Presentation. A 30-year-old female patient presented to our clinic with a left anterior neck mass for a few months with dysphagia. The lipoma was excised completely along with level II to IV lymphadenectomy. A very small volume chyle leak was noted intraoperatively. The drain was removed 2 weeks later only to recur in one month. A new drain was placed by interventional radiology, and the drainage resolved completely. Discussion. The patient with mild dysphagia had a lipoma large enough to push vital structures away from their normal anatomical position. Due to the difficult location and the size of the lipoma, a meticulous formal lateral neck dissection was required. A 3D imaging like CT or MRI would be helpful to preoperatively plan the dissection. Substernocleidomastoid neck lipoma in our case is a rare benign tumor that was challenging to excise.

Objective To evaluate the accuracy and reliability of a simple, single-camera smartphone-based method, named the Reflex Tracker (RT) system, for measuring reflex threshold angles related to ankle clonus and quadriceps hyperreflexia. Design A prospective comparison study using a high-fidelity reference standard was constructed employing a 2 × 2 × 2 factorial design, with factors of rater (tester) type (student and experienced physical therapist), joint (ankle and knee), and repetition (2 per condition). Setting This multicenter study was conducted at 4 outpatient rehabilitation clinics. Participants A convenience sample of 14 individuals with a neurologic condition presented with 20 lower limbs that exhibited ankle clonus and/or quadriceps hyperreflexia and were included in the study. Also participating in the study were 8 student and 8 experienced physical therapist raters (testers) (N=16). Interventions Not applicable. Main Outcome Measures The plantar flexor reflex threshold angle (PFRTA) related to ankle clonus and the quadriceps reflex threshold angle (QRTA) related to quadriceps hyperreflexia were quantified. Results PFRTA and QRTA results were compared between the smartphone RT method and synchronous 3-dimensional inertial measurement unit (IMU) sensor motion capture. Mean difference (bias) was minimal between RT and IMU measurements for PFRTA (bias≤0.2°) and QRTA (bias≤1.2°). Intrarater reliability for PFRTA ranged from 0.85-0.90 using RT and from 0.85-0.87 using IMU; QRTA ranged from 0.97-0.98 using RT and from 0.96-0.99 using IMU. Intersensor reliability for PFRTA and QRTA was 0.97 and 0.99, respectively. Minimum detectable change for PFRTA ranged from 7.1°- 8.7° and for QRTA ranged from 6.1°-8.3°. Conclusions RT performed comparable to IMU for accurate and reliable measurement of PFRTA and QRTA to quantify ankle clonus and quadriceps hyperreflexia in clinical settings.