Neck Pain in a 12-Year-Old Female: An Unusual Diagnosis.
BACKGROUND
Neck pain in the pediatric population has a broad differential diagnosis, ranging from benign to imminently life-threatening causes. Trauma and infection represent the most common etiologies of pediatric neck pain in the pediatric emergency department (PED) setting. Malignancy, though a rare cause of pediatric neck pain, is important to consider in patients with acquired torticollis or focal neurologic signs.


METHODS
We describe the case of a previously healthy 12-year-old female who presented to the PED with neck pain radiating down her upper extremities. The physical examination revealed diminished strength in her upper extremities compared to her lower extremities. Further evaluation revealed lymphadenopathy in the cervical and mediastinal areas and an epidural tumor in the cervical spinal column. The ultimate diagnosis was Hodgkin lymphoma presenting in an unusual manner with cervical spinal cord compression. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Neck pain is a common chief complaint among pediatric patients in the emergency setting. This case of spinal cord compression caused by malignancy illustrates the necessity of detailed spinal imaging in patients with neck pain and "red flag" signs, including but not limited to an abnormal neurologic examination.
Pediatric Residency Program, The Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
Regina L
RL
Toto
Division of Pediatric Emergency Medicine, Department of Pediatrics, The Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
Noel S
NS
Zuckerbraun
Division of Pediatric Emergency Medicine, Department of Pediatrics, The Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
Mioara D
MD
Manole
D002574:Cervical Vertebrae; D002648:Child; D003937:Diagnosis, Differential; D015174:Epidural Neoplasms / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006689:Hodgkin Disease / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D019547:Neck Pain / Q000209:etiology*; D013117:Spinal Cord Compression / Q000209:etiology
Hodgkin lymphoma; neck pain; pediatrics; spinal cord compression; torticollis