Medical Mystery: The case of the black eye in the morning

After a year of getting a black eye overnight, Emory Special Diagnostic Services solved Caroline Kalchthaler's mystery

Top Doctors 2018

Illustration by Chris Gash

Caroline Kalchthaler woke up one morning with a black eye, as if she had been punched or fallen out of bed and hit her face. But no such thing had happened. She tenderly covered it with makeup, and the bruising subsided.

But then the black eye occurred again, and again. Kalchthaler noticed that her face was drooping, but just on the side with the black eye. “I would wake up and my face would be swollen, and it would look like I had been crying or had a stroke overnight,” says Kalchthaler, 37, who is a provider relations coordinator for a healthcare network in Greenville, South Carolina.

Kalchthaler went to a family physician, oral surgeon, and an ear, nose, and throat doctor and tried taking steroids for inflamed sinuses. She went to a dentist to check her wisdom teeth. But the swelling continued off and on for about a year.

At the time, Kalchthaler worked for a radiology practice as a marketing manager. One of the radiologists scanned her neck and saw irregular lymph nodes and a lump. Kalchthaler feared she had cancer. An ENT in South Carolina performed a biopsy, and, while it came out benign, the cyst began to grow until it was just smaller than a ping-pong ball. Kalchthaler’s black eye started appearing daily.

Kalchthaler and her husband traveled from their home in Seneca, South Carolina, to Emory to learn definitively what it was—and to get it removed.

Diagnosis: Branchial cleft cyst. Dr. Thomas Jarrett, an internist with Emory Special Diagnostic Services, examined Kalchthaler and arranged for additional tests to make sure there weren’t any other underlying problems. This cyst is a birth defect usually found in children, but sometimes it isn’t discovered until adulthood. It occurs when neck tissues form improperly during the earliest stages of development. In Kalchthaler’s case, the cyst began pressing on facial nerves, especially when she slept. Dr. Mihir Patel, a head and neck surgeon at Emory, removed the cyst about a month after her initial visit at the diagnostic clinic. Her black eyes are gone.

This mystery was solved by Emory Clinic’s Special Diagnostic Services. For more about the clinic, check out our story, Doctor Detective.

This article appears in our July 2018 issue.