Retropharyngeal calcific tendinitis: case report and review of literature

Abstract

Retropharyngeal calcific tendinitis, also known as acute calcific prevertebral tendinitis or longus colli tendinitis, is an uncommon benign condition presenting as acute neck pain. Clinically, it can be misdiagnosed as retropharyngeal abscess, traumatic injury, or infectious spondylitis. The diagnosis is made radiographically by an amorphous calcification anterior to C1-C2 and prevertebral soft tissue swelling. We present three cases of this uncommon condition to illustrate the classic findings on plain film, CT, and MRI. Recognition of the pathognomonic imaging appearance allows for easy diagnosis preventing unnecessary tests and treatment.

Acute calcific tendinitis of the longus colli muscle: case report and review of the literature

“…The most common characteristic triad of symptoms for this disease consists of acute neck pain, neck stiffness and odynophagia [1,2]. In addition, the haematological analysis may show mild elevation of erythrocyte sedimentation rate (ESR) accompanied by low grade pyrexia and mild leukocytosis [1,3,5,10]. Nevertheless, several other symptoms and clinical findings may be associated with this entity such as dysphagia, sore throat, limited range of neck motion, pharyngeal oedema, erythema of nasopharynx and neck spasm [1,3].…”

“…The exact aetiology of calcium hydroxyapatite crystals deposition is not wellknown, but some authors hypothesize that repetitive trauma, ischaemia, necrosis and tendinous degeneration play a role in the pathogenesis of retropharyngeal tendinitis [3,5,6]. The degenerative calcification hypothesis was supported by Mohr and Bilger describing calcific tendinopathies as a result of tendon cells necrosis and subsequent intracellular calcium accumulation [13].…”

“…The most important mimicker of longus colli tendinitis is retropharyngeal abscess [1,5,9]. Despite showing the same clinical presentation, these two entities can be differentiated with a CT scan, the most appropriate method to reveal the characteristic calcareous deposition at the C1-C3 vertebral level [3,4].…”

“…Acute calcific tendinitis of the longus colli muscle tends to be a self-limiting disease [1,3,5,6]. Non-steroidal antiinflammatory drugs (NSAIDs) are the first-line treatment, but in severe cases additional drugs, like corticosteroids or opioids, are suggested [1,3,7,8].…”

“…Immobilization with soft cervical collar is another useful method to avoid aggravation of symptoms [1]. The symptoms, usually, begin to resolve within a couple of days from the initiation of treatment and the patients become symptom-free after 1-3 weeks [3,5,[10][11][12].…”