Halla J T, Bliznak J, Hardin J G, Finn S
Department of Radiology, Hendrick Medical Center, Abilene, Texas.
Arthritis Rheum. 1991 Jan;34(1):84-8. doi: 10.1002/art.1780340113.
We present the case of a 76-year-old man who experienced the sudden development of fever, rightsided neck pain and stiffness, and torticollis. A soft tissue mass was noted on the right side of his neck, but his head was tilted to the left. Computed tomography scans (with reformatted sagittal and coronal images) of the patient's cervical spine revealed destructive changes of the right lateral masses of C1 and C2 and the clivus, and a well-delineated peridontoid soft tissue mass (confirmed by magnetic resonance imaging). After the second episode of right-sided hemiparesis, he underwent transoral surgical exploration, with anterior decompression and odontoidectomy. Histologic examination of the surgical material revealed granulation tissue, fibrosis, and chronic inflammation, consistent with abscess formation with invasion and compression of the spinal cord and bone. This case suggests that nonreducible rotational head tilt to the side opposite the side of lateral mass collapse should raise the suspicion of a possible infection.
我们报告了一例76岁男性患者，该患者突然出现发热、右侧颈部疼痛及僵硬，伴有斜颈。其右侧颈部可触及一软组织肿块，但头部向左倾斜。对患者颈椎进行计算机断层扫描（包括矢状位和冠状位重建图像）显示，C1和C2右侧侧块及斜坡有破坏性改变，以及一个边界清晰的齿状突周围软组织肿块（磁共振成像证实）。在第二次出现右侧偏瘫后，他接受了经口手术探查，进行了前路减压和齿状突切除术。手术材料的组织学检查显示为肉芽组织、纤维化和慢性炎症，符合脓肿形成并侵犯和压迫脊髓及骨骼。该病例提示，向侧块塌陷对侧不可复位的旋转性头部倾斜应引起对可能感染的怀疑。
