Introduction: Accurate techniques for measurement of head and neck lymphedema and fibrosis (LEF) are lacking. Shear wave elastography (SWE) is a new sonographic method to assess soft tissue elasticity. Objective: To present a case report of a head and neck cancer (HNC) patient with LEF whom was assessed using SWE. Methods: A 41-year-old patient with HNC developed LEF after his cancer treatment. The patient underwent LEF therapy in a timely fashion and self-care for LEF; nonetheless, the patient developed severe fibrosis. Results: This case describes the patient with progressive skin/soft tissue changes related to LEF. SWE demonstrated dramatically increased shear wave velocity, which corresponded to a marked decrease in the soft tissue elasticity of the neck. Conclusion: This case report highlights the importance of monitoring and managing LEF long term in the HNC population. SWE may prove to be a useful tool for clinicians to identify skin/soft tissue changes related to LEF that require intervention. Further investigation of this tool is ongoing.