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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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IMAGING IN INFECTIOUS TORTICOLLIS

Catarina Perry da Câmara1, Teresa Morais1, Marcos Veiga1, Mariana Cardoso Diogo1,2, Isabel Fragata1, Carla Conceição1

1 - Department of Neuroradiology, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa
2 - Department of Radiology, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria

- Congresso Nacional SPNR, 1 a 4 de junho 2017, Estarreja

Purpose: Torticollis is a common entity in children, usually of muscular origin and without need for imaging or further work up. Given that, infections of the head and neck region may directly or indirectly lead to torticollis, some of which are life threatening. The goal of our paper is to review causes of infectious torticollis and their imaging characteristics in one pediatric center.
Methods: A review of neuroimaging requests for torticollis was performed in our center. Infectious causes then were assessed and images and clinical files of those patients carefully reviewed.
Findings/Discussion: Infectious etiologies identified included Grisel syndrome, cat scratch disease (bartonella infectious sinovitis), pyogenic meningitis (Salmonella, E. coli), viral lymphadenitis, pyogenic lymphadenitis, amygdalin abscess and infectious cerebellitis. In all patients imaging studies were suggestive of infection. Computed tomography and magnetic resonance imaging helped to direct the infectious agent search in the depicted cases, either by direct or indirect findings.
Conclusion: Infectious causes of torticollis must be excluded when a child presents with an acquired torticollis, as some might be life threatening. They include a vast number of pathogens, from viral to fungal and bacterial, across a large number of possibly affected structures. Imaging studies of the head and neck can help the clinician in many ways; by suggesting infectious origin in clinically obscure cases, by delineating the structures affected and imaging characteristics perhaps suggesting or narrowing down the infectious agent, by directing the tissue/fluid to be studied and/or the specific zone from which to collect biologic material, when necessary. Knowledge of these imaging patterns is essential to the radiologist, but also helpful for the clinician evaluating the child.

Palavras Chave: children; imaging; infectious torticollis; MRI