Acute longus colli calcific tendinitis

Case contributed by Dr Seamus O'Flaherty

Presentation

Neck stiffness and pain, dysphagia, and pharyngitis for several days.

Patient Data

Age: 40 years
Gender: Male

Cervical spine

X-ray

The upper anterior prevertebral soft tissues are thickened, particularly at the level of the adenoids. No soft tissue gas or calcification. Straightening of the normal cervical lordosis, with mild disc space loss at C4/5 and C6/7 with endplate lipping. Prior undisplaced fracture of the C7 spinous process. No acute bony abnormality. Several teeth been extracted, with suspected caries in an upper molar.

Cervical spine

CT

7 mm prevertebral fluid with C2 prevertebral calcification likely in keeping with longus colli calcific tendinitis, with fluid reactive to pharyngitis considered less likely.

Cervical spine

MRI

Cloud-like calcification anterior to C1, right midline. Associated with an increased T2 hyperintensity and enhancement of the right longus colli muscle. Minor changes in adjacent longus capitis muscle. Fluid collection inferiorly, extending from C1 to C5 with an AP dimension of 8 mm. Small volume fluid is noted between the dens and the anterior arch of C1 articulation. No deep space collection.

Case Discussion

Acute calcific longus colli tendinitis, also known as retropharyngeal or acute calcific prevertebral tendinitis, is a reactive self-limiting inflammatory response to acute or subacute deposition of amorphous calcium hydroxyapatite crystals in the tendons of the longus colli muscle, anterior to the C1-C2 disc space.

The patient’s presentation could be easily misdiagnosed as a retropharyngeal abscess. However, the presence of subtle findings on CT would lead to the correct diagnosis. The management of this condition is mainly with non-steroidal anti-inflammatory drugs (NSAIDs). Monitoring of upper airway obstruction is important as large reactive prevertebral collections may indirectly compress the airway.

This patient recovered well with a course of oral NSAIDs.

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