The ultrasound images above show a mass like lesion of the right side of neck in a 2 year old child.
No vascularity was present on color Doppler ultrasound.
The mass in the child was extremely tender and painful.
No other pathology or symptoms were found.
Diagnosis:
Pseudotumor of the neck or Torticollis or wry neck
Pseudotumor of the neck, also known as fibromatosis colli, is a benign soft tissue mass that can occur in infants with torticollis. Ultrasound imaging can be used to diagnose and monitor the condition. In this blog post, we will discuss the specific findings of pseudotumor of the neck on ultrasound imaging of torticollis.
Ultrasound Findings of Pseudotumor of the Neck:
Pseudotumor of the neck typically presents as a hypoechoic mass in the sternocleidomastoid muscle, which is the muscle responsible for head and neck movement. The mass may appear well-defined or ill-defined, and it may have a homogeneous or heterogeneous echotexture. In some cases, pseudotumor of the neck may also have a cystic component.
On ultrasound imaging, pseudotumor of the neck may also appear as a thickening of the sternocleidomastoid muscle. This can cause the muscle to appear elongated and narrow, which can contribute to the characteristic head tilt seen in torticollis.
It is important to note that pseudotumor of the neck can be difficult to distinguish from other soft tissue masses, such as lymphadenopathy or hematoma. In some cases, further imaging or biopsy may be necessary to confirm the diagnosis.
What are the differential diagnoses in this case?
Torticollis, or wry neck, is a condition characterized by a tilt or rotation of the head, often resulting in a stiff or painful neck. In a 2-year-old child, the following are the top differential diagnoses for torticollis:
1. Congenital muscular torticollis: This is the most common cause of torticollis in infants and young children, resulting from the shortening or tightening of the sternocleidomastoid muscle, which connects the collarbone and breastbone to the skull.
2. Cervical spine injury: Trauma to the neck or cervical spine can result in torticollis in children. It is important to evaluate for any signs of trauma or abuse in these cases.
3. Ocular or visual problems: Children with eye or vision problems may develop a head tilt or turn to compensate for poor visual acuity or alignment.
4. Infections: Infections such as meningitis or encephalitis can cause torticollis in children. Other signs of infection such as fever, lethargy, or irritability should be evaluated.
5. Neurological conditions: Neurological conditions such as cerebral palsy, dystonia, or seizures can present with torticollis as a symptom.
6. Tumor or mass: A tumor or mass in the neck or head can cause torticollis in children, and should be evaluated by a healthcare professional.
Management of Pseudotumor of the Neck:
The management of pseudotumor of the neck typically involves observation and monitoring. In most cases, the mass will resolve on its own over time without the need for surgical intervention. However, if the mass is causing significant discomfort or if it is not resolving on its own, surgical excision may be necessary.
In addition to surgical intervention, physical therapy may also be recommended to help improve head and neck movement and prevent the development of long-term complications associated with torticollis.
Conclusion:
Pseudotumor of the neck is a benign soft tissue mass that can occur in infants with torticollis. Ultrasound imaging can be used to diagnose and monitor the condition. Specific ultrasound findings associated with pseudotumor of the neck include a hypoechoic mass in the sternocleidomastoid muscle, as well as thickening and elongation of the muscle. Management of pseudotumor of the neck typically involves observation and monitoring, although surgical excision may be necessary in some cases. Physical therapy may also be recommended to prevent long-term complications associated with torticollis.
(Images courtesy of Dr Golam)
For more info on this topic visit:
Also:
No comments:
Post a Comment