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Clinical Problem Solving: Radiology
September 2009

Radiology Quiz Case 1

Author Affiliations
 

C. DOUGLASPHILLIPSMD

Arch Otolaryngol Head Neck Surg. 2009;135(9):940. doi:10.1001/archoto.2009.133-a

A 3-year-old boy presented with a stiff neck and dysphagia associated with a 38°C fever, which had lasted for a few hours. Otherwise, he was in general good health, and there was no evidence of dysphonia or dyspnea.

Physical examination revealed only hypertrophic bilateral cervical lymph nodes. Biological assessment demonstrated an inflammatory syndrome with hyperleukocytosis (white blood cells, 19 200/μL [to convert to ×109/L, multiply by 0.001]) and an elevated level of C-reactive protein (121.0 mg/L [reference value, <5.0 mg/L] [to convert to nanomoles per liter, multiply by 9.524]). A standard cervical x-ray film (Figure 1) and contrast-enhanced computed tomograms with sagittal reconstructions (Figure 2, Figure 3, and Figure 4) were obtained.

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