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Clinical Problem Solving: Radiology
July 2005

Radiology Quiz Case 2

Author Affiliations
 

R. NICKBRYANMDPATRICIA A.HUDGINSMD

Arch Otolaryngol Head Neck Surg. 2005;131(7):647. doi:10.1001/archotol.131.7.647

A 7-year-old girl presented with a 1-week history of odynophagia, dysphagia, swelling of the left side of her neck, and a temperature of 38.9°C. Her medical history was unremarkable, and her childhood vaccinations were up to date. Physical examination revealed left-sided peritonsillar cellulitis and a soft, nonpulsatile, level II swelling of the left side of her neck. Her C-reactive protein level (312 mg/L) and white blood cell count (34.2 × 103/μL) were elevated, as was her neutrophil count. A venous blood sample yielded group A streptococci, but the results of a glandular fever screen and other blood tests were normal. Intravenous antibiotic therapy was initiated. The next day, left-sided torticollis and Horner syndrome developed. A contrast-enhanced computed tomographic scan (Figure 1 and Figure 2) was performed.

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