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A pain in the neck
  1. Ayeshea Zacharkiw,
  2. Helen Williams
  1. Radiology Department, Birmingham Children's Hospital, Birmingham, UK
  1. Correspondence to Dr Helen Williams, Radiology Department, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK; helen.williams{at}

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From questions on page 71.


The correct answer is C; langerhans cell histiocytosis (LCH). The second lateral cervical spine radiograph shows complete collapse of C3 vertebral body (figure 4, arrowed), also called a vertebra plana, with abnormal vertebral alignment indicating cervical spine instability.

Figure 4

LCH is a non-neoplastic proliferative disorder of histiocytes/dendritic cells (Langerhans cells being the histiocytes limited to skin). Clinical presentation can vary widely and LCH has historically been described as a number of different entities such as eosinophilic granuloma, Hand-Schüller-Christian disease and Letterer-Siwe disease often just representing the extent of organs/tissues involved. Treatment of LCH is based on risk stratification dependent on the extent of disease at presentation, namely; single bony-site, multiple bony-site or multisystem (multiorgan) involvement. Significant mortality is associated with multisystem disease in patients aged less than 2 years. Patients with only bone involvement have the best prognosis. LCH is seen from birth …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.