Acute longus colli tendinitis and otolaryngology

Abstract

Introduction: Acute longus colli tendinitis is caused by calcium hydroxyapatite deposition in the tendon of the longus colli muscle with subsequent inflammation. The calcifications are commonly located at the superior oblique portion at the level of the C1-C2 vertebrae. The typical clinical presentation consists of acute neck pain, odynophagia, and painful limitation of neck range of motion.

Objectives: We will describe this disease with three that cases presented to our institution and compare the findings on imaging studies.

Methods: We retrospectively reviewed the clinical data, radiological features, and laboratory reports of three patients diagnosed with acute longus colli tendinitis. Computed tomography and plain radiographs were reviewed and compared by a single radiologist. A contemporary review of the literature was conducted using PubMed (Medline), Embase, and Cochrane library databases.

Results: Computed tomography showed greater sensitivity for the detection of the pathognomonic calcification than plain radiographs and facilitated the exclusion of other more severe conditions by following a systematic interpretation composed of five key elements. Plain radiographs showed non-specific signs of prevertebral soft tissue swelling and a decreased cervical lordotic curve. However, no calcification was identified on plain radiographs. The literature review revealed 153 articles containing 372 cases. Surgical or invasive procedures were mentioned in 13.7% of publications and were performed in 28 patients.

Conclusion: Acute longus colli tendinitis can mimic the clinical presentation of more severe conditions that the otolaryngologist may be required to evaluate, such as infectious, traumatic, and neoplastic diseases. Knowledge of this entity, with its pathognomonic imaging findings, can prevent misdirected medical therapy and unnecessary invasive procedures.

Keywords: Longus colli; Neck pain; Retropharyngeal abscess; Tendinitis; Tendinopathy.

Figure 1

A 48-year-old woman with acute longus coli tendinitis. A, Plain radiograph showing thickness of prevertebral soft tissues and decreased cervical lordotic curve. B, Sagittal view of a computed tomography scan of the same patient showing the same findings and the typical amorphous calcifications (black arrowhead) at the level of the C1–C2 vertebrae, not visible on the plain radiograph. C, Axial view at the level of C2 vertebrae demonstrating the amorphous calcifications (black arrow) and increased thickness of prevertebral soft tissues.