Retropharyngeal effusion secondary to calcific tendinitis of the longus colli muscle: A case report and brief review of the literature

Abstract

Calcification or ossification of the longus colli tendon is a rare and often underdiagnosed cause of acute neck pain, typically seen in middle-aged adults, especially women. This condition results from the deposition of calcium hydroxyapatite crystals in the tendon, causing an inflammatory or granulomatous response. Common symptoms include neck pain, painful swallowing, and fever. CT imaging is the preferred diagnostic tool, showing retropharyngeal and prevertebral effusions with minimal or no peripheral enhancement, often accompanied by calcifications in the superior fibers of the longus colli tendon. This condition can be mistaken for a retropharyngeal abscess, which requires more invasive management, such as drainage. In contrast, calcific tendinitis responds well to conservative treatment, including nonsteroidal anti-inflammatory drugs (NSAIDs). Here, we report a case of retropharyngeal effusion secondary to calcific tendinitis of the longus colli muscle, highlighting the importance of distinguishing it from other conditions, such as retropharyngeal abscess, to avoid unnecessary invasive treatments.

Keywords: Longus colli tendonitis; Retropharyngeal effusion.

Fig. 1

Contrast-enhanced CT of the neck in the soft tissue window, showing axial (A) and sagittal (B) images, demonstrating a large retropharyngeal effusion without peripheral enhancement (black arrows).

Fig. 2

Contrast-enhanced CT of the neck in the bone window, showing axial (A) and sagittal (B) images, highlighting calcification within the superior fibers of the left longus colli muscle tendon at the C1/C2 level (black arrows).

Fig. 3

Initial CT of the neck, showing axial (A) and sagittal (B) reformatted images, and repeat CT of the neck, showing axial (C) and sagittal (D) images performed 5 days later at the same level, demonstrating complete resolution of the retropharyngeal effusion (black arrows).