Man with neck pain

Clinical introduction A 43-year-old man without medical history presented to ED with a 10-day history of neck pain. At triage, his body temperature was 39.6oC and blood pressure was 95/55 mm Hg. On physical examination, there was posterior neck swelling and stiffness without neurological deficit. Blood tests revealed white cell count of 35 930/mm3 and C reactive protein of 29.6 mg/dL. Neck plain radiography was performed (figure 1). Question What is the most likely diagnosis? Cervical spine fracture Oesophageal rupture Meningitis Necrotising fasciitis Answer: D. Necrotising fasciitis (NF) The plain film showed multiple heterogeneous radiolucent lesions (figure 2, arrow) along the posterior cervical spine. Head and neck CT revealed loculated fluid with gas formation (). C-spine MRI showed dorsal epidural enhancement (). Cervical necrotising fasciitis (CNF) with epidural space involvement was confirmed. After admission, broad-spectrum antibiotics were administered. Both...

Source: Emergency Medicine Journal - May 23, 2023 Category: Emergency Medicine Authors: Liu, C.-I., Hsu, Y.-P., Kuo, C.-L. Tags: EMJ Image Challenge Source Type: research