Calcific Tendonitis of the Longus Colli Muscle: A Noninfectious Cause of Retropharyngeal Fluid Collection

Calcific tendonitis of the longus colli (CTLC) muscle is an underrecognized cause of spontaneous acute or subacute neck pain, dysphagia, or odynophagia. Imaging may reveal a retropharyngeal fluid collection leading to the presumed diagnosis of retropharyngeal abscess. Recognition of this uncommon presentation is important to prevent unnecessary surgical incision and drainage. A 44-year-old otherwise healthy male presented with a 2-week history of progressive neck pain, stiffness, and odynophagia. A noncontrast CT scan of the cervical spine revealed a retropharyngeal fluid collection with a small area of calcification anterior to C2. There was a presumed diagnosis of retropharyngeal abscess. The patient was afebrile with normal vital signs. Flexible nasolaryngoscopy was unremarkable. C-reactive protein was elevated but all other bloodwork was normal with no evidence of an infective process. A CT scan was repeated with IV contrast showing no enhancement around the fluid collection. A diagnosis of CTLC was made. The patient was successfully managed with a short course of intravenous steroids and oral NSAIDs with complete resolution of symptoms. Clinically CTLC can mimic more serious disease processes. Identifying pathognomonic imaging findings often confirms the diagnosis. Awareness of this condition by the otolaryngologist will ensure proper patient management and avoidance of unnecessary procedures.

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Acute Calcific Tendinitis of the Longus Colli: Not All Retropharyngeal Fluid is an Abscess

Ear Nose & Throat Journal ◽

10.1177/0145561320943347 ◽

2020 ◽

pp. 014556132094334

Author(s):

Ellen Ko-Keeney ◽

Rick Fornelli

Keyword(s):

Fluid Collection ◽

Calcific Tendinitis ◽

Retropharyngeal Abscess ◽

Upper Cervical Spine ◽

Laboratory Findings ◽

Radiographic Findings ◽

Radiologic Findings ◽

Longus Colli ◽

Anchoring Bias ◽

Acute Calcific Tendinitis

Objective: This report aimed to present a case of acute calcific tendinitis of the longus colli muscle as an uncommon cause of neck pain and dysphagia and is often misdiagnosed as a retropharyngeal abscess. Methods: Case report and literature review. Results: Acute calcific tendinitis is often misdiagnosed as a retropharyngeal abscess; however, it is distinguished from the latter based on patient history and unique radiologic findings. History, examination, and laboratory findings do not suggest an infectious etiology, and radiographic findings include a non-rim-enhancing fluid collection with or without calcifications anterior to the upper cervical spine. Conclusion: Unlike retropharyngeal abscess, acute calcific tendinitis is managed conservatively. When consulted for a possible retropharyngeal abscess, the otolaryngologist should avoid anchoring bias by independently obtaining a detailed history and examination and personally reviewing radiologic images to avoid unnecessary intervention.

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Acute longus colli calcific tendonitis causing neck pain and dysphagia

Otolaryngology ◽

10.1016/j.otohns.2007.12.004 ◽

2008 ◽

Vol 138 (3) ◽

pp. 405-406 ◽

Cited By ~ 11

Author(s):

Katherine Southwell ◽

Jeremy Hornibrook ◽

David O'Neill-Kerr

Keyword(s):

Neck Pain ◽

Longus Colli ◽

Calcific Tendonitis

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Retropharyngeal Calcific Tendonitis Mimics a Retropharyngeal Abscess

Case Reports in Otolaryngology ◽

10.1155/2013/818561 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Natasha Pollak ◽

Sonya Wexler

Keyword(s):

Case Reports ◽

Treatment Options ◽

Fluid Collection ◽

Treatment Strategies ◽

Retropharyngeal Abscess ◽

Retropharyngeal Space ◽

Appropriate Treatment ◽

Calcific Tendonitis ◽

Limiting Condition ◽

Operative Drainage

Retropharyngeal calcific tendonitis (RCT) is an uncommon, self-limiting condition that is often omitted in the differential diagnosis of a retropharyngeal fluid collection. This condition mimics a retropharyngeal abscess and should be considered when evaluating a fluid collection in the retropharyngeal space. Although calcific tendonitis at other sites has been well described in the medical literature, it appears that this entity has been underreported in the otolaryngology literature where only a few case reports have been identified. Presumably, the actual incidence is higher than the reported incidence, due to lack of familiarity with this disorder. As an otolaryngologist’s scope of practice includes the managements of retropharyngeal lesions, it is important for the otolaryngologist to recognize the presentation of acute RCT and be familiar with appropriate treatment strategies. Retropharyngeal calcific tendonitis presents with neck pain, limitation of neck range of motion and includes inflammation, calcifications, and a sterile effusion within the longus colli muscle. Treatment is medical with nonsteroidal anti-inflammatory medications. RCT does not require surgical treatment, and an accurate diagnosis can prevent unnecessary attempts at operative drainage. In this study, we discuss two cases of RCT, summarize the salient features in diagnosis, including key radiologic features, discuss treatment options, and review the literature.

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Calcific tendonitis of the longus colli muscle: A cause of atraumatic neck pain

Annals of Emergency Medicine ◽

10.1016/s0196-0644(85)80253-5 ◽

1985 ◽

Vol 14 (10) ◽

pp. 1014-1017 ◽

Cited By ~ 20

Author(s):

David M Widlus

Keyword(s):

Neck Pain ◽

Longus Colli ◽

Calcific Tendonitis ◽

Longus Colli Muscle

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Retropharyngeal tendinitis: Hydroxyapatite deposition driven headache and nuchal rigidity resolves with prednisone

Case Reports in Internal Medicine ◽

10.5430/crim.v5n1p1 ◽

2017 ◽

Vol 5 (1) ◽

pp. 1

Author(s):

Abhimanyu Amarnani ◽

Yair Saperstein ◽

Isabel M McFarlane ◽

David J Ozeri

Keyword(s):

Neck Pain ◽

Clinical Work ◽

Sudden Onset ◽

Retropharyngeal Abscess ◽

Retropharyngeal Space ◽

Empirical Antibiotic Treatment ◽

Nuchal Rigidity ◽

Calcific Tendonitis ◽

Retropharyngeal Tendinitis ◽

Work Up

We present a case of a 42-year-old woman who presented with sudden onset severe headache, neck pain, and nuchal rigidity associated with dysphagia. The initial differential in this patient included meningitis or retropharyngeal abscess, and an extracranial neck CT showed an ill-defined hypo-attenuated lesion within the retropharyngeal space. However, the neck pain and dysphagia were unresponsive to empirical antibiotic treatment and pain management. Further CT with contrast identified acute calcific tendonitis of the longus colli tendon, also known as retropharyngeal tendonitis (RCT). Although RCT is already known as a rare, self-limiting inflammatory condition, we present a new case of RCT, with the uncommon features of headache and nuchal rigidity in an aseptic patient, while providing a diagnostic flow chart to guide the clinical work-up of similar presentations to also include RCT.

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