title: Imaging of torticollis in children.
abstract: The normal anatomy of the cervical spine and various imaging techniques for the evaluation of torticollis are reviewed, and possible causes of torticollis in infants and children are discussed, with an emphasis on relevant imaging findings. Torticollis is a congenital or acquired deformity characterized by rotational deformity of the cervical spine with secondary tilting of the head. Although torticollis is a sign of an underlying disease process, its presence does not imply a specific diagnosis, and the cause should be sought if torticollis persists or is associated with other symptoms. Congenital torticollis, seen in neonates and infants, usually results from craniocervical vertebral anomalies or muscular causes, although ocular abnormalities such as congenital paralytic squint (strabismus) and congenital nystagmus should also be considered. Acquired torticollis, seen in older children and adolescents, is often secondary to trauma, infection, or tumors. Imaging should be used as a general screening tool only after a complete medical history and clinical findings have been obtained. In newborns or infants with congenital torticollis, ultrasonography (US) is the modality of choice. In cases of acquired torticollis resulting from trauma, conventional radiography (lateral and anteroposterior views) should be the first-line imaging modality. In nontraumatic acquired torticollis, computed tomography (CT) of the neck or cervical spine is the initial imaging study. If CT findings are negative, magnetic resonance (MR) imaging of the brain and cervical spine should be performed. The use of multiple imaging modalities (conventional radiography, US, CT, and MR imaging) is common in the radiologic work-up of torticollis, and radiologists must understand the role of each imaging modality in patients of various ages.
authors.affiliation: Department of Radiology, Manchester Academic Health Sciences Centre, Royal Manchester Children's Hospital, Oxford Rd, Manchester M13 9WL, England. sairahaque@doctors.org.uk
authors.forename: Saira
authors.initials: S
authors.lastname: Haque
authors.forename: Badar Bin
authors.initials: BB
authors.lastname: Bilal Shafi
authors.forename: Musa
authors.initials: M
authors.lastname: Kaleem
mesh_terms: D000293:Adolescent; D001268:Atlanto-Axial Joint / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D001269:Atlanto-Occipital Joint / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D001720:Birth Injuries / Q000150:complications; D001921:Brain / Q000473:pathology; D002493:Central Nervous System Diseases / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D016543:Central Nervous System Neoplasms / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D002574:Cervical Vertebrae / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D007231:Infant, Newborn; D008022:Ligaments / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000379:methods; D009135:Muscular Diseases / Q000150:complications / Q000151:congenital / Q000175:diagnosis; D019838:Neck Injuries / Q000150:complications / Q000175:diagnosis; D013123:Spinal Fusion; D013125:Spinal Neoplasms / Q000150:complications / Q000175:diagnosis; D013904:Thoracic Vertebrae / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D014103:Torticollis / Q000151:congenital / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D014463:Ultrasonography