Age / Sex : 42 / F

Chief complaint :

 Neck pain

Discussion

Answer: 

Acute calcific tendinitis of the longus colli muscle

(Acute calcific longus colli tendinitis)

Findings:

CT

Nodular calcification in the longus colli muscle, prevertebral space (C2 level)

Diffuse prevertebral soft tissue swelling.

MRI  :

1. Calcification in the longus colli muscle, prevertebral space (C2 level)


2. Contrast enhancement, in longus colli muscle, prevertebral space.


3. Diffuse soft tissue edema and fluid collection, in prevertebral space.

Differential Diagnosis:

Retropharyngeal abscess, traumatic injury

Discussion:

-  Acute calcific longus colli tendinitis (retropharyngeal or acute calcific prevertebral tendinitis) is a reactive self-limiting inflammatory condition presumably caused by calcium hydroxyapatite deposition in the longus colli muscle.

-  Characteristic radiographic finding - calcifications in the superior longus colli muscle tendons at the level of C1 or C2.

-  Computed tomography - gold standard for diagnosis of retropharyngeal tendinitis, since it can detect both prevertebral edema and calcium hydroxyapatite crystal deposition in longus colli tendons.

-  Magnetic resonance imaging (MRI) - can detect prevertebral edema and fluid effusion, however, it has a poor sensitivity to detect calcific deposits

2. Abdelbaki A, Abdelbaki S, Bhatt N, Gupta N, Li S, Ghasemiesfe A, Kumar Y. Acute Calcific Tendinitis of the Longus Colli Muscle: Report of Two Cases and Review of the Literature. Cureus. 2017 Aug 23;9(8):e1597.

3. Colella DM, Calderón Sandoval F, Powers DW, Patel N, Sobrado J. A Rare Cause of Dysphagia to Remember: Calcific Tendinitis of the Longus Colli Muscle. Case Rep Gastroenterol. 2016 Dec 13;10(3):755-759.