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Clinical Problem Solving
August 2014

Odynophagia, Neck Pain, and Stiffness

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, West Virginia University School of Medicine, Morgantown
  • 2Department of Otolaryngology, West Virginia University School of Medicine, Morgantown
JAMA Otolaryngol Head Neck Surg. 2014;140(8):777-778. doi:10.1001/jamaoto.2014.965

A woman in her 30s presented with a 4-day history of worsening odynophagia, sore throat, and neck pain and stiffness. She was 9 weeks pregnant at the time of presentation, without apparent complications, and had no history of head and neck surgical procedures. She was afebrile, and results from routine laboratory tests were notable for a slight leukocytosis, with white blood cell count of 13 800/μL (13.8 × 109/L) and elevated erythrocyte sedimentation rate (ESR) of 30 mm/h. Physical examination revealed diffuse tenderness to palpation of the left lateral and posterior sides of her neck. Flexible fiber-optic laryngoscopy showed a widely patent airway without bulging of the posterior or lateral pharyngeal walls. A lateral neck radiograph was first obtained, which showed questionable prevertebral widening at the C2 level. Magnetic resonance imaging (MRI) of the cervical spine and brain without contrast was performed. The choice of imaging was based on the fact that the patient was pregnant. The MRI scan of the cervical spine revealed edema in the prevertebral and retropharyngeal spaces extending from the skull base to the C5 level (white arrowheads in Figure, A and B). There was no evidence of discitis or any other sources of infection. The orthopedic spine service was subsequently consulted and recommended surgical incision and drainage. A computed tomographic (CT) scan of the neck with intravenous (IV) contrast was then ordered prior to any surgical intervention. It showed calcifications anterior to the C1-C2 level (black arrowheads in Figure, C and D).

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