RETROPHARYNGEAL CALCIFIC TENDINITIS

Introduction

Retropharyngeal calcific tendinitis is, or acute calcific prevertebral tendonitis a rare disease. The superior part of the longus colli muscle is affected. The disease is a result of calcium hydroxyapatite deposition in the longus colli muscle and associated inflammation. Classically, the calcification affects the superior oblique portion of the longus colli muscle at the C1-C2 level.

It is characterized by acute onset of severe pain and stiffness of the neck (2). Swallowing and movements of the head aggravate pain. There may be a mild fever, leukocytosis, and an elevation of the erythrocyte sedimentation rate, raising the suspicion of retropharyngeal infection. The condition is treated with non-steroidal anti-inflammatory drugs (NSAIDs). Mean duration of symptoms are 5 days (range 3–7 days).

Case Report

A 27-old male patient was presented with neck pain. He also confirmed that the pain increases with swallowing. Complaints of neck pain and restricted movements of neck, led the clinican to perform an MRI examination, to rule out servical disc disease. MRI showed prevertebral T1- and T2-hypointense oval nodular lesion in C3 level (Figure-1 and Figure-2, arrows). On T2 weighted images, there was also mild fluid collection in retropharyngeal space (Fig-1, arrowheads). Moderate contrast enhancement, consistent with inflammation is observed around the lesion, extending down into lower servical prevertebral areas (Figure-2, arrowheads). CT examination revealed large, oval, nodular calcification of longus colli tendon (Figure-3, arrow).

This disease has a typical clinicoradiologic presentation. The radiologist needs to be familiar with this disease, because the symptoms are in a common localisation of a variety of medical specialists. In most instances, initial clinical misdiagnosis tends to be the rule rather than the exception.

References

1) J. Gelineck, M. Salomonsen, C. Hviid. Retropharyngeal Tendinitis: Radiographic and Magnetic Resonance Imaging Findings. Acta Radiologica (2006); 47: 8, 806-809.
2) Ferns M. Hall, William P. Docken, and Hayes W. Curtis. Calcific Tendinitis of the Longus Coli: Diagnosis by CT. AJR (1986); October, 147: 742-743.
3) Michel De Maeseneer, Sarah Vreugde, Steven Laureys, David J. Sartoris, Filip De Ridder, RA,1 Michel Osteaux. Calcific Tendinitis of the Longus Colli Muscle. Head Neck (1997); September, 19: 545–548.

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