Clinical Case 1
Julian Moncada, M.D.
Josiah Han, M.D.
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.
Past Medical Hx:
Review of Systems
Constitutional: Negative for fevers, chills, activity change, fatigue
HR: 127 bpm
Gen: Active, in no acute distress, tilting head to the right otherwise well appearing.
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)
There are no acute abnormalities.
Adenoidal hypertrophy with narrowing of the nasopharyngeal airway.
Click for diagnosis and more
Diagnostic test: MRI Cervical Spine w/wo Contrast
Sore Throat (76%)
Consult ENT- most cases require I & D
Can give Dexamethasone 0.15mg/kg-0.6mg/kg up to 10mg for inflammation and edema
Back to our patient...
CT: Large abscess within the prevertebral soft tissues of the posterior nasopharynx.
Admitted to general peds floor