Adolescent presenting with bilateral neck and shoulder pain
Notice: Authors are encouraged to submit quizzes for possible publication in the Journal. These may be in any specialty, and should approximately follow the format used here (maximum of 2 figures). An 18-year-old girl presented with a 6-month history of slight bilateral neck and shoulder pain. The pain was constant and exacerbated when abducting her upper extremity. The pain was described as better at night. Medications, including aspirin, offered little relief. A hard unmoveable mass could be felt in the cervical back, approximately 10x8 cm in size. The neurological examination was normal with the exception of dysesthesia in the C5 dermatome. Routine serologic tests were all normal. Her family and medical history were unremarkable. Preoperative plain radiographs showed the osteolytic lesion located in the vertebral body and posterior elements of C5 with pathological anterolisthesis at the C4 level. The computed tomography (CT) scan of the cervical spine demonstrated a large expansile multiseptated mass, with a size of approximately 7.0x5.5x3.0 cm, containing fluid-fluid levels, involving the posterior elements, the pedicle, and the vertebral body of C5, and causing effacement of the C4/5 neural foramen. There was compression of the spinal cord mainly at the level of C5. Fortunately, the vertebral artery is not encased by the disease process. Magnetic resonance imaging (MRI) of the spine demonstrated a local destructive tumorus lesion of the fifth cervical vertebrae with compression of the spinal cord and paravertebral involvement (Figure 1). Figure 1-Photograph showing A & B) Computerized tomography scan of the cervical spine showing a large expansile multiseptated mass, containing fluid-fluid levels, involving the posterior elements, the pedicle, and the vertebral body of C5. C &D) Magnetic imaging resonance at the level of C5, demonstrating a cystic lesion with fuid-on-fuid levels with extension into the spinal canal.