Age / Sex : 52 / M

Chief complaint :

Sore throat, swallowing difficulty X 1 day ago

What is your impression?
Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy of Hahn Seok, Inje University college of medicine, Haeundae Paik Hospital

Discussion

Answer: 

Calcific tendinitis of longus colli muscle

Findings:

1) C-spine Lateral view

Lateral view shows diffuse prevertebral soft tissue thickening with subtle calcification at the anterior aspect of C2.

2) T1WI, T2WI, T1FCE sagittal MR images

 T1WI, T2WI and T1WI fat-suppression contrast enhanced sagittal MR show diffuse soft tissue swelling at C1-5 pre-vertebral space with irregular T1 and T2 low signal intensity lesion at anterior aspect of C2. There is no fracture of cervical vertebrae and remarkable bone marrow signal change in cervical spine.

Differential Diagnosis:

1. retropharyngeal abscess


2. trauma

Discussion:

Calcific tendinitis of the longus colli muscle is caused by deposition of calcium hydroxylase apatite crystals at the C1-C2 and rarely C5-C6 vertebral levels in the 3rd to 6th decades. Patients are often misdiagnosed with retropharyngeal abscess because they have similar symptoms and imaging findings; however, calcific tendinitis of the longus colli muscle often develops suddenly. Nonsteroidal anti-inflammatory drugs or a brief course of steroids are treatment options. Amorphous calcifications may be seen on radiographs and CT. CT may provide a more accurate estimate of the calcific tendinitis of the longus colli muscle rather than radiograph. On CT, amorphous calcifications are typically seen in the superior fibers of the longus colli muscle tendons at the C1-C2 level. The characteristic findings on CT are a fluid collection in the retropharyngeal space without or with minimal contrast enhancement. MRI will easily demonstrate the prevertebral edema, however, the delicate care should be taken to detect the calcification deposition.

References:

AJNR Am J Neuroradiol. 1998 Oct;19(9):1789-92.

Eur J Radiol. 2016 Jul;85(7):1247-56.