Case of the Month 12: Presentation

by James Hassel • June 5, 2015 • 2 Comments

Ok ladies and gents, here is the final CotM for this academic year, why not marinate on a peds case.

You are working in the peds emergency department when an ortho resident brings in a patient from his clinic for you to evaluate for torticollis.

You are presented with a 7 y/o boy with a PMH of scoliosis and asthma. He was brought for his regular scoliosis appointment, but his mother shares that for two weeks the patient cannot turn his head completely due to pain and stiffness. Last week, she had to pick him up early from school because he was complaining of pain in his L arm that was radiating from his neck, however he has not had pain since. The patient says he had a sore throat and cough before the stiffness started; his mother says he is always coughing due to asthma. Those symptoms have now resolved. His scoliosis is mild, involving his thoracic spine. Has never had neck problems before.

Denies trauma, falls, twisting, head manipulation, fevers, chills, N/V/D, sick contacts, recent travel, headache, vision changes, numbness, tingling, weakness.

Meds Albuterol prn

VS HR 95, BP 115/70, afebrile, RR 14, Sat 100% on RA

PE normal aside from

Head is tilted to the R

Decreased ROM of neck in both directions

L cervical muscle spasm and tenderness

L anterior and posterior cervical LAD

Oropharynx clear with no evidence of abscess or exduates

Please discuss this case by answering these questions:

What is your RANKED differential in this pediatric patient with torticollis?

What will your workup include?

What is your management for your chosen diagnosis?

Good luck, winner gets the usual fame and fortune and a free beverage on me.

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.