Age / Sex : 43 / M

Chief complaint : Posterior neck pain for 2 weeks

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 : Jinkyeong Sung, St. Vincent’s hospital

Discussion

Answer: Calcific tendinitis of longus colli muscle

Findings:  

1. CT) Amorphous calcification anterior to C1-C2 and prevertebral soft tissue thickening.


2. MR) Dark signal intensity calcification anterior to C1-C2.

Prevertebral soft tissue swelling, edema and enhancement from C1 to C5 level.

Calcification in the superior fibers of the longus colli muscle on axial image.

Differential Diagnosis: Retropharyngeal abscess

Diagnosis: Calcific tendinitis of longus colli muscle

Discussion: Calcific tendinitis of the longus colli muscle is retropharyngeal inflammatory process caused by calcium hydroxyapatite deposition. It usually affects superior oblique tendon fibers of longus colli muscle. On plain radiography, characteristic imaging findings are prevertebral soft tissue swelling, and amorphous calcification anterior to C1– C2. Prevertebral effusion or edema is demonstrated on CT or MR imaging, typically from C1 to C4. The calcification in the superior tendon fibers of the longus colli muscle can assist the correct diagnosis. It is self-limiting disease and spontaneously resolve in 1-2 weeks.

References:

1. Skeletal Radiol (2010) 39:817–820


2. The British Journal of Radiology, 82 (2009), e117–e121


3. Emergency Radiology (2005) 11: 375–380