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Clinical Problem Solving: Radiology
Feb 2012

Radiology Quiz Case 2

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2012;138(2):199. doi:10.1001/archoto.2011.1193a

A previously healthy 3-year-old girl presented to the pediatric emergency department with a 6-day history of fever, torticollis, and throat pain. According to her mother, she had been walking with her head cocked to the right side of her body and rotated toward the left. She was refusing to move her neck and was febrile, normotensive, and alert. She also was refusing all oral intake. She had undergone rapid strep test, with positive results, 3 days earlier. At that time, oral cephalexin was prescribed; however, her condition failed to improve, and she subsequently presented to the emergency department. On admission, her white blood cell count was slightly elevated at 19 430/μL (to convert to ×109/L, multiply by 0.001) (reference range, 4500-11 000/μL). Computed tomograms (CTs) of the head and neck initially revealed a 28 × 12-mm ring-enhancing fluid collection in the left retropharynx at the level of the C1-C4 vertebrae (Figure 1). Axial CTs demonstrated an enlarged atlantodens interval of 4.0 mm on the left and 7.0 mm on the right (Figure 2). C1 was rotated left and anteriorly in relation to C2 (Figure 3).