A 64-year-old active male smoker presents to the ER with a left cervical mass along with a several-day history of high fever and general malaise. Upon physical examination, a 7 cm × 4 cm mass is noted, with active purulence and a stony-hard consistency upon palpation (Fig. 1). The emergency chest and cervical CT scan reveals the presence of an 8 cm × 9 cm (Fig. 3) large soft tissue mass on the left lateral cervical area of heterogeneous density and bubbles inside (Fig. 2) invading the deep fat planes and fistulized to the exterior consistent with a malignant abscessed mass. The patient is admitted to the ICU due to septic shock and receives intensive treatment. The definitive diagnosis is neoplasm of the base of the tongue with abscessed metastatic adenopathy.

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