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

Abstract

Purpose: Acute calcific tendinitis of the longus colli muscle (or retropharyngeal tendinitis) is an aseptic inflammatory process characterized by acute posterior neck pain, neck stiffness and dysphagia or odynophagia. Awareness of its existence is crucial in the differential diagnosis, because many other conditions, such as retropharyngeal abscess, meningitis or disc herniation, show similar clinical features. We present a case exhibiting an uncommon symptom (torticollis) and a brief literature review to emphasize the risk of misdiagnosis.

Methods: A 36-year-old woman presented with neck stiffness and torticollis accompanied by dysphagia and prevertebral space sensitivity on the second day.

Results: The diagnosis was established by computed tomography (CT), the gold standard for identifying the presence of prevertebral oedema and calcific deposition associated with retropharyngeal tendinitis. Treatment with NSAIDs and low doses of corticosteroids relieved the symptoms within 48 h.

Conclusions: Retropharyngeal tendinitis is an underreported entity in the literature and orthopaedists should become aware of its existence. Misdiagnosis of this important mimicker may lead to unnecessary antibiotics administration and interventions in the retropharyngeal space.

Fig. 1

Cervical spine plan X-rays, face (a) and profile (b), no specific findings were noticed

Fig. 2

a T2 W TSE sagittal view. b B-FFE transverse view. Both of them reveal an extended prevertebral oedema (arrows) without finding of abscess

Fig. 3

Cervical CT on C1–C2 level (a) and C3 level (b) reveal multiple small punctate calcific deposits (arrows) in the mass of longus colli muscle

Fig. 4

Schematic illustration of the three parts of longus colli muscle