Retropharyngeal calcific tendonitis is an inflammatory process of the superior oblique tendons of the longus colli muscle, a neck flexor in the upper cervical spine, caused by deposition of calcium hydroxyapatite crystals; the definitive diagnostic test is computed tomography (CT). Presented in this article are two cases seen at our institution. Patients typically present with acute onset of neck pain/spasm, odynophagia, dysphagia, and/or low grade fevers. Leukocytosis and elevated erythrocyte sedimentation rate may be noted. It is important to understand this entity because its signs and symptoms are mimickers of those of the more serious condition of retropharyngeal space abscess. Calcific tendonitis is managed conservatively whereas retropharyngeal abscess requires incision and drainage. Some may argue that this entity is a zebra because its reported incidence in the literature is low. However, most of these studies were done in an era when CT was not yet in vogue. With today's widespread use of CT and its superb ability to visualize the calcification, the true incidence of this condition is probably higher and, thus, it is important for the family practitioner to be aware of this entity. The astute clinician may save the patient from unnecessary diagnostic workup, undue anxiety, and delays in hospital discharge. Case 1A 30-yr-old female with no significant past medical history presented with a 3-day history of rightsided neck pain, exacerbated by movement and intake of food. Two days prior, the patient was seen at a community hospital and diagnosed with torticollis. She was discharged with nonsteroidal antiinflammatory drugs (NSAIDs) and a muscle relaxant without significant improvement.There was no history of strenuous activity, hoarseness, shortness of breath, nausea, vomiting, antecedent injury, neck pain, or arthritic disorder. White blood cell count was normal at 7900 cells per mm 3 . Blood culture showed no growth. Patient was afebrile.The physical examination was positive for right para-cervical point tenderness and limited range of motion in all directions. There was no retropharyngeal asymmetry, bulge, or neck lymphadenopathy noted. The uvula was midline.Cervical spine radiograph showed no fracture or subluxation; no abnormal calcification was noted. CT of the neck with intravenous contrast demonstrated fluid in the retropharyngeal space without wall enhancement, adjacent to the longus colli muscles. No definite abscess was noted. In retrospect, a small amorphous calcification was seen at the anterior C1-C2 level (see Figures 1-3). This crucial finding of calcification was missed by the radiologist; only the finding of the nonspecific fluid collection was noted in the radiology report. If the calcification had been noted, a definitive diagnosis of retropharyngeal calcific tendonitis could have been made, and the workup would have concluded. However, because the calcification was not picked up and the patient's symptoms were quite concerning, magnetic resonance imaging of the neck was performed, wh...

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The objective of this research was to determine the sensitivity and specificity of a commercially available computer-aided detection (CAD) system for detection of lung nodule on posterior-anterior (PA) chest radiograph in a varied patient population who are referred to computed tomographic angiogram (CTA) of the chest as a reference standard. Patients who had a PA chest radiograph with concomitant CTA of the chest were included in this retrospective study. The PA chest radiograph was analyzed by a CAD device, and results were recorded. A qualitative assessment of the CAD results was performed using a 5-point Likert scale. The CTA was then reviewed to determine if there were correlative nodules. The presence of a correlative nodule between 0.5 cm and 1.5 cm was considered a positive result. The baseline sensitivity of the system was determined to be 0.707 (95% CI=0.52-0.86), with a specificity of 0.50 (95% CI=0.38-0.76). Positive predictive value was 0.30 (95% CI=0.24-0.49), with a negative predictive value of 0.858 (95% CI=0.82-0.95), and accuracy of 0.555 (95% CI=0.40-0.66). When excluding nodules that were qualitatively determined by a thoracic radiologist to be false positives, the specificity was 0.781 (95% CI=0.764-0.839), the positive predictive value was 0.564 (95% CI=0.491-0.654), the negative predictive value was 0.829 (95% CI=0.819-0.878), and the accuracy was 0.737 (95% CI=0.721-0.801). The use of CAD for lung nodule detection on chest radiograph, when used in conjunction with an experienced radiologist, has a very good sensitivity, specificity, and accuracy.

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History A 6-day-old female neonate presented to the outpatient pediatric surgery clinic for evaluation of a possible prenatal abdominal mass. The neonate was delivered at term via cesarean section due to macrosomia, with a reported birth weight of 11 lb 8.7 oz (5.23 kg). The patient's postnatal course was remarkable for resolving neonatal hyperbilirubinemia. A physical examination was remarkable for a palpable mass in the abdomen. Maternal risk factors included class II obesity, type 2 diabetes, and metabolic syndrome. Prenatal images obtained at an outside institution were not available at this time. Ultrasonography (US) of the abdomen and pelvis was performed 6 days after birth. Follow-up US at 29 days of life revealed no substantial change in the appearance of the findings. This patient remained asymptomatic, and gadolinium-enhanced (Magnevist; Bayer Pharma, Berlin, Germany) magnetic resonance (MR) imaging of the abdomen and pelvis was performed at 84 days of life. The mass was excised surgically at 89 days of life, and the patient had an uncomplicated postoperative course.