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Neck Pain and Fever

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 52-year-old female with a history of diabetes and stroke presents to the ED for 3 days of atraumatic neck pain that started left posterior.  She denied any weakness or fever but temperature was 38.2.  No other complaints.

Vital Signs & Physical Exam:

Vital signs are normal except for the temperature.  Physical exam is otherwise normal except for a very stiff neck in any plane of motion

Initial Differential Diagnosis:

  • Disc injury
  • Meningitis
  • Epidural abscess
  • Vertebral dissection

Initial Diagnostic Testing:

  • EKG: none
  • Labs: Sed rate elevated at 80, WBC elevated at 13
  • Imaging: CT angio of the neck was ordered to rule out dissection.  See below.

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows calcific tendonitis on the longus colli tendon (see arrow) This was not originally noted on the CT but was picked up on the MR that followed and was done to rule out epidural abscess.
  2. What should you do next?  Treat with analgesics.  Consult spine
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: Went home with Norco and spine follow-up

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