Female, 8 years old, with history of a flulike illness last week (1/26-1/30) with headache, fever, cough and rhinorrhea. Brain MRI done for headaches, occipital, now resolved. Incidental anterior cervical fluid noted of unclear etiology. Dedicated MRI cervical spine was performed. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. The mucosa of the ethmoid air cells and sphenoid sinuses is mildly T2 hyperintense suggesting inflammation.C-spine:A thin layer of freely tracking T2 hyperintense material, presumably fluid, is evident within the retropharyngeal space of the upper cervical region. At most, this fluid measures 2 mm in thickness. The tissues surrounding this fluid show mild enhancement on postcontrast images. No evidence of any loculated or discrete rim enhancing collection is seen.The above finding occurs in the context of bilateral and symmetric enlarged adenoidal and palatine tonsillar tissues as well as prominent lateral retropharyngeal lymph nodes.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. No evidence of marrow space or disk edema is seen. No pathologic spinal enhancement is detected. The spinal canal and the neural foramina are patent throughout. The spinal cord demonstrate normal morphology and signal characteristics.
1. A thin layer of freely tracking fluid within the retropharyngeal space of the upper cervical region probably represents a reactive effusion, particularly given the patient's history and the presence of symmetrically enlarged tonsillar and retropharyngeal nodal tissues. No evidence is seen to suggest discrete abscess. No involvement of the spine or spinal canal is suspected.2. Unremarkable evaluation of the brain.