Severe neck pain and odynophagia secondary to acute calcific longus colli tendinitis: a case report

Abstract

Background: Acute calcific longus colli tendinitis is a rare, noninfectious inflammatory condition caused by the deposition of calcium crystals. The condition is self-limiting, yet commonly misdiagnosed. Here we report a case of a patient with severe neck pain and odynophagia initially misdiagnosed as a retropharyngeal abscess before establishing the correct diagnosis of acute calcific longus colli tendinitis. Case presentation: A 60-year-old Caucasian man presented to an outside emergency department with a 5-day history of neck pain and odynophagia. The neck pain was severe and aggravated by movement. Laboratory evaluation revealed leukocytosis and elevated C-reactive protein. Computed tomography of his neck soft tissues was initially interpreted as a retropharyngeal abscess. Antibiotic therapy with piperacillin/tazobactam was initiated, and the patient was transferred to our tertiary care center for further evaluation and treatment. On physical examination, the patient's neck range of motion was significantly diminished, and bilateral neck tenderness was present. An otolaryngologist performed an examination with laryngoscopy, the result of which was unremarkable. A radiologist at our facility interpreted his outside magnetic resonance imaging as showing "calcification in the prevertebral muscles at C1-C2, inflammation with edema of the prevertebral muscles, and retropharyngeal space edema/effusion," consistent with acute calcific longus colli tendinitis. His antibiotics were discontinued, and he was started on intravenous ketorolac. He had significant improvement in his neck range of motion, and his pain diminished greatly. He was discharged on a 10-day course of diclofenac (50 mg three times daily). At 1-week follow-up, the patient was doing well; he had returned to work, and his pain was well controlled. Conclusions: This case report details the presentation, characteristic radiographic findings, and management of a patient with an extremely rare condition of neck pain and odynophagia that could be treated with nonsteroidal antiinflammatory drugs.

Calcific tendinitis of the longus colli: An uncommon cause of neck pain

“…Frequently misdiagnosed, the incidence of Calcific tendinitis of the longus colli remains unknown [4] , however, J. Boardman [10] reported in 2017, in his study a frequency of 1.1 per 1000 examinations. The Risk factors consist of repetitive trauma, recent injury degenerative cervical disorders, osteoarthritis, tissue necrosis, renal failure [3] , ischemia, and vascular disease [4 , 8] .…”

“…The clinical features of calcific tendinitis of LCM are variable, the typical symptoms encompass severe neck pain with limited neck movement that is accompanied by dysphagia or odynophagia, and headache [3 , 8] . The duration of symptoms before presentation ranges from one day to three months [1] .…”

“…Pathognomonic imaging findings on CT-scan include amorphous calcifications in the longus colli muscle with retropharyngeal edema [3 , 8] . The calcifications feature may vary considerably from subtle to quite obvious [3] .…”

“…MRI may be useful to show features related to edema and inflammatory reaction and non–enhancing retropharyngeal effusion [3 , 8] .…”

Retropharyngeale Tendinitis

“…Es gilt, mittels gezielter Diagnostik durch sensibilisiertes Personal einerseits Fehldiagnosen und hierdurch bedingte In Zusammenschau der verfügbaren Befunde (konventionelles Röntgen, CT, Labor) sind auch bei stationärer Aufnahme des Patienten prophylaktische Antibiotikagaben, Feinnadelpunktionen, Lumbalpunktionen oder gar eine operative Exploration nicht nötig und sollten somit auch dringend vermieden werden. Die Abnahme von Blutkulturen ist bei vorliegender Verdachtsdiagnose der retropharyngealen Tendinitis zwar nicht notwendig, kann aber die Diagnose der retropharyngealen Tendinitis hinzukommend sichern [2, 6,7].…”