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Findings

Oval enlargement of the right sternocliedomastoid muscle

Similar attenuation to muscle

Adjacent soft tissues normal

No adjacent lymphadenopathy

Differential Diagnosis

Fibromatosis Coli

Muscular torticollis

Myositis related to neck infection

Rhabdomyosarcoma

Lymphadenopathy

Teratoma

Fibromatosis Coli

Non-neoplastic SCM muscle enlargement in infancy

Fibrocollagenous infiltration of SCM

Etiology

Post traumatic with intramuscular hemorrhage with subsequent fibrosis

Associated with breech presentation and forceps delivery

Fibromatosis Coli

Presentation

Unilateral cervical longitudinal neck mass

Torticollis in up to 20%

Infant with non-tender neck mass

Natural History

Mass appears within two weeks of delivery

Mass may increase in size for days to weeks after presentation

Usually regresses by 8 months of age

20% progress to muscular torticollis despite conservate therapy

Treatment

Watchful waiting for normal spontaneous resolution

Physical therapy

Tenotomy in cases with torticollis that fail conservative therapy

Harnesberger, HR: Diagnostic Imaging-Head and Neck. Salt Lake City, 2004, Amirsys Inc.