WIDI - CA0149-Prevertebral Musculotentinous, CT

Prevertebral Musculotentinous, CT

Claim CME Credit

0.5 CME Credit available on completion

POINT OF CARE INFORMATION

This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.

Learning Objectives

As a result of participation in this activity, participants should be able to:

Provide improved patient care.
Greater knowledge of the imaging characteristics of the patient's disease.
Understand a better approach to interpretation of studies.

Faculty Disclosure

Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.

CME Advisory Committee Disclosure:

Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.

Continuing Medical Education Credit

Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CA0149-Prevertebral Musculotentinous, CT

History

42-year old male emergency room with fever and with neck pain. Evaluate for possible complicated pharyngitis, retropharyngeal or epidural abscess.

Exam

Contrast-enhanced CT of the maxillofacial region and neck and related anatomy with images obtained in the balanced or venous vascular phase to ensure optimal visualization of both arterial and venous structures as well as possible reactive changes around infected collections. 0.5-3.0 mm thick sections were obtained in the axial plane and reformatted 3D and/or in the coronal and sagittal planes and viewed inter actively in 3 dimensions at the computer work station.

Prior Study

N/A

Findings

General

There is edema of the soft tissues limited to the prevertebral and retropharyngeal spaces in the midneck as discussed subsequently.

Nasopharynx including retropharyngeal lymph nodes

Nasopharynx and retropharyngeal space and lymph nodes are normal.

Oropharynx

The oropharynx is normal.

Hypopharynx, larynx, deep neck and entire retropharyngeal space

There is no edema, phlegmon or developing abscess arising from the hypopharynx, larynx, thyroid gland or trachea.

There is no evidence of a branchial or other origin infected developmental cyst.

Prevertebral and epidural spaces:

There is edema within the retropharyngeal space at the oro- and hypopharyngeal level without distinct enhancement or thickening of the overlying mucosa. The edema involves the prevertebral space predominantly and is more prominent on the left side and, in general, at the level of the hypopharynx.

There is no evidence of an abscess within in the epidural space. There is no evidence of discitis or vertebral osteomyelitis.

Impression

The patient’s symptoms appear to be caused by prevertebral musculo-tendinitis. Based on these imaging findings, the left longus colli muscle is the most likely muscle group that is inflamed. An MRI could be done for further confirmation of this diagnosis.

Recommendations

The emergency medical service was called at the time of completion of the study because of their concern about possible retropharyngeal abscess or epidural abscess and informed that the patient’s symptoms were due to a relatively benign disease process.