Clinical Case 1

Julian Moncada, M.D.

Josiah Han, M.D.

Our Patient


7 Year old F with hx of asthma presenting to the ED with neck pain. Pain started about 2 weeks ago after sleeping on Dad’s couch. Mom tried alternating tylenol and motrin for pain with some relief, but pain continued to persist and was taken to OSH where X-ray of the C-Spine was done and told was normal. Discharged home with instructions to follow up with orthopedics for persistent MSK pain and continue motrin use.  

Presents to the ED today for worsening pain. Mother states patient woke up in the middle of the night crying in pain. Pain is located to the back of her neck with a posterior headache as well. States that the pain is worse with flexion and extension. Decreased PO intake secondary to pain. Mom also reports the patient has been tilting her head to the right for the past day. No recent falls or trauma. Denies any fevers, chills, nausea/vomiting, coughing, rhinorrhea, rashes, or known sick contacts. 


Past Medical Hx:

Surgical Hx:

Social Hx:

Family Hx

Review of Systems

Constitutional: Negative for fevers, chills, activity change, fatigue

HENT: Negative for congestion, rhinorrhea, sore throat, trouble swallowing

Eyes: Negative for visual disturbance

Respiratory: Negative for apnea, coughing, choing, SOB

Gastrointestinal: Negative for abdominal pain, distention, constipation, diarrhea, N/V

GU: Negative for decreased urine volume, dysuria, vaginal pain, rashes

MSK: + posterior neck pain, negative for back pain, joint pain, extremity swelling

Skin: Negative for wounds or rashes

Vital Signs

Physical Exam




X-ray C-spine

Findings: Normal alignment. No fractures or subluxation. Unremarkable soft tissues. Limited visualization of C1 and C2 on the open-mouth view.

Impression: Limited study. No fractures or subluxation.

CT Soft Tissue Neck (OSH 4 days prior to current presentation)


Click for diagnosis and more

Retropharyngeal Abscess

Diagnostic test: MRI Cervical Spine w/wo Contrast

Clinical Features:




By Physical: 

By imaging: 





Consult ENT- most cases require I & D


Can give Dexamethasone 0.15mg/kg-0.6mg/kg up to 10mg for inflammation and edema


Grisel's Syndrome

Non-traumatic atlantoaxial subluxation associated with inflammatory conditions of the head/neck

Back to our patient...


Extensive inflammatory process extending from the anterior skull base to the level of C5 including prevertebral fluid and an abscess anterior to the clivus with associated atlantoaxial subluxation

CT: Large abscess within the prevertebral soft tissues of the posterior nasopharynx. 

Case Resolution