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Turner VL, Martinez C, Rocha J, Valenzuela A. Acute calcific tendinitis of the longus colli: A case report. Radiol Case Rep 2024; 19:2650-2653. [PMID: 38645950 PMCID: PMC11031716 DOI: 10.1016/j.radcr.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 04/23/2024] Open
Abstract
Acute calcific longus colli tendinitis is a differential diagnosis of neck pain. Typical presentation consists in a triad of symptoms including acute onset neck pain, neck stiffness and odynophagia. Computed tomography (CT) is the gold standard for acute calcific longus colli tendinitis diagnosis and the main radiological findings include prevertebral soft tissue swelling and the presence of amorphous calcifications. The case involves a 39-year-old female who presented to the emergency department with acute unilateral cervical pain that resulted in acute calcific longus colli tendinitis.
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Affiliation(s)
| | - Camila Martinez
- Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Judith Rocha
- Department of Rheumatology and Clinical Immunology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonia Valenzuela
- Department of Rheumatology and Clinical Immunology, Pontificia Universidad Católica de Chile, Santiago, Chile
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2
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Syed AZ. Soft Tissue Calcifications in the Head and Neck Region. Dent Clin North Am 2024; 68:375-391. [PMID: 38417996 DOI: 10.1016/j.cden.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
This article provides an overview of the soft tissue calcifications in the head and neck region as noted on dental imaging, with particular focus on the radiographic appearance of these entities..
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Affiliation(s)
- Ali Z Syed
- Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine - Case Western Reserve University, 9601 Chester Avenue, Cleveland, OH 44106, USA.
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3
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Delbello F, Spinnato P, Aparisi Gomez MP. Calcific Tendinopathy Atypically Located Outside the Rotator Cuff: A Systematic Review. Curr Med Imaging 2024; 20:e100423215585. [PMID: 37038296 DOI: 10.2174/1573405620666230410091749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/24/2023] [Accepted: 02/20/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND AND PURPOSE Calcific tendinopathy is a common cause of painful shoulder easily identified with ultrasound or conventional radiography. Although the rotator cuff is by far the most common location of the disease and diagnostic or treatment strategies are well known in clinical practice, a lack of awareness characterizes the assessment of the other sites affected by this condition; consequently, the risk of underestimating the prevalence of atypical non-rotator cuff calcific tendinopathy is high. This may lead to expensive or invasive diagnostic exams and/or inappropriate treatment, whereas the condition is usually self-limited. The present study aims at analysing the frequency of calcific tendinitis in uncommon sites, in order to fill a gap in knowledge and awareness regarding non-rotator cuff calcific tendinopathy, thus avoiding improper clinical choices and helping to identify this condition. METHODS This systematic review was conducted following the PRISMA guidelines. We performed a search on Pubmed and Scopus databases concerning atypically sited extra-rotator cuff calcific tendinopathy published since 1950. RESULTS The research found a total of 267 articles and 793 non-rotator cuff cases of calcific tendinopathy registered. The spine (213 – 26.86%), foot and ankle (191 – 23.95%), and hip (175 – 22.06%) appeared to be the most common sites of calcific tendinopathy after the rotator cuff, whereas the longus colli C1-C2 (204 – 25.72%), Achilles (173 – 21.81%), and rectus femori (61 – 7.69%) were the most commonly affected tendons. CONCLUSION A better awareness of this condition in several different sites of the body than the rotator cuff could avoid unnecessary choices both in assessment and treatment.
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Affiliation(s)
- Federica Delbello
- Department of Rehabilitation Medicine, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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4
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Cheong LA. Acute Calcific Tendinitis of the Longus Colli Muscle Masquerading as Acute Meningitis: A Case Report and Review of the Literature. Cureus 2023; 15:e43400. [PMID: 37706123 PMCID: PMC10495865 DOI: 10.7759/cureus.43400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/15/2023] Open
Abstract
We present a case report of a young female who presented with acute neck pain, odynophagia, and fever. These symptoms were suggestive of possible differential diagnosis including meningitis and retropharyngeal abscess. Subsequent radiological investigations led to a diagnosis of acute calcific tendonitis of the longus colli muscle. Typical clinical presentations and radiological findings of this rare condition are discussed.
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Affiliation(s)
- Li Anne Cheong
- General Medicine/Internal Medicine, Sengkang General Hospital, Singapore, SGP
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5
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Ong W, Kuah T, Eide SE, Hallinan JTPD. Neck pain with prevertebral soft tissue thickening. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:520-522. [PMID: 36047531 DOI: 10.47102/annals-acadmedsg.2022112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Wilson Ong
- Department of Diagnostic Imaging, National University Hospital, Singapore
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6
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Qureshi PAAA, Bollason G, Ágústsson KL. Acute Calcific Tendinitis of the Longus Colli Muscles: An Entity That Should Be Known by Emergency Radiologists. Cureus 2022; 14:e25518. [PMID: 35800797 PMCID: PMC9245335 DOI: 10.7759/cureus.25518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/09/2022] Open
Abstract
Acute calcific tendinitis of the longus colli muscle (LCM) also called acute calcific prevertebral tendinitis or retropharyngeal tendinitis is an inflammatory process of the LCM that results in acute and debilitating symptoms. Although the imaging appearances of this uncommon condition are specific, due to the rarity of this entity and lack of familiarity, it can be sometimes misdiagnosed as a retropharyngeal abscess. This case report presents characteristic radiological features of the acute calcific tendinitis of the LCM, which may be helpful for the emergency radiologist to accurately diagnose this condition to avoid unnecessary surgical interventions.
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7
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Siag K, Mazzawi S, Paker M, Biener R, Ghanayim R, Lumelsky D. Acute longus colli tendinitis and otolaryngology. Braz J Otorhinolaryngol 2020; 88:351-357. [PMID: 33342696 PMCID: PMC9422725 DOI: 10.1016/j.bjorl.2020.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/20/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022] Open
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. CONCLUSIONS 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.
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Affiliation(s)
- Kfir Siag
- Emek Medical Center, Department of Otolaryngology Head and Neck Surgery, Afula, Israel.
| | - Salim Mazzawi
- Emek Medical Center, Department of Otolaryngology Head and Neck Surgery, Afula, Israel
| | - Miki Paker
- Emek Medical Center, Department of Otolaryngology Head and Neck Surgery, Afula, Israel
| | - Roy Biener
- Emek Medical Center, Department of Otolaryngology Head and Neck Surgery, Afula, Israel
| | - Rami Ghanayim
- Emek Medical Center, Department of Otolaryngology Head and Neck Surgery, Afula, Israel
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8
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Draghi F, Cocco G, Lomoro P, Bortolotto C, Schiavone C. Non-rotator cuff calcific tendinopathy: ultrasonographic diagnosis and treatment. J Ultrasound 2020; 23:301-315. [PMID: 31197633 PMCID: PMC7441123 DOI: 10.1007/s40477-019-00393-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/31/2019] [Indexed: 12/13/2022] Open
Abstract
Calcific tendinopathy is a condition that is related to the deposition of calcium, mostly hydroxyapatite crystals, within the tendons. The shoulder and the hip are commonly affected joints, but calcific tendinopathy may occur in any tendon of the body. While there is an extensive literature on the ultrasound diagnosis of calcific tendinopathy of the shoulder, there are only sporadic reports on other sites. This review combines the experience of our centers and a thorough analysis of the literature from the last 45 years (1972-2017) in order to highlight the localizations beyond the rotator cuff, their ultrasound characteristics and therapeutic possibilities.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Giulio Cocco
- Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy
| | - Pascal Lomoro
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Chandra Bortolotto
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy.
| | - Cosima Schiavone
- Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy
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Ko-Keeney E, Fornelli R. Acute Calcific Tendinitis of the Longus Colli: Not All Retropharyngeal Fluid is an Abscess. EAR, NOSE & THROAT JOURNAL 2020; 101:78-80. [PMID: 32720813 DOI: 10.1177/0145561320943347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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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Affiliation(s)
- Ellen Ko-Keeney
- Department of Otolaryngology, University of Pittsburgh Medical Center Hamot, Erie, PA, USA
| | - Rick Fornelli
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
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10
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Lee SYC, Gan YJ, Goh JPN, Ho YH, Lim MY. Laryngeal gout mimicking chondrosarcoma with concurrent longus colli tendinitis. BMJ Case Rep 2019; 12:e231070. [PMID: 31653628 PMCID: PMC6827773 DOI: 10.1136/bcr-2019-231070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 11/04/2022] Open
Abstract
A 42-year-old man with multiple comorbidities, including gout, presented to the emergency department with severe odynophagia for 4 days with intermittent dysphagia for 1-2 months. A CT scan of the neck showed right longus colli tendinitis and partially calcified excrescences from the right thyroid cartilage which raised suspicion of a cartilaginous tumour. He underwent an MRI scan of the neck to better evaluate the thyroid cartilage findings, which showed a heterogeneous mass suspicious for a chondroid tumour. He then underwent a positron-emission tomography-CT scan which showed a fluorodeoxyglucose-avid mass containing foci of calcification involving the right thyroid cartilage and adjacent strap muscle, with high standardised uptake value of 7.7. He subsequently underwent a CT-guided biopsy and an open biopsy of the right thyroid cartilage, and the results revealed gouty tophi. To our knowledge, this is the first reported case of laryngeal gout with longus coli tendinitis, both of which are rare conditions.
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Affiliation(s)
| | - Yijin Jereme Gan
- Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Yong Howe Ho
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ming Yann Lim
- Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
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11
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Shen Y, Zhou Q, Zhu X, Qiu Z, Jia Y, Liu Z, Li S. Vertigo caused by longus colli tendonitis: A case report and literature review. Medicine (Baltimore) 2018; 97:e13130. [PMID: 30407336 PMCID: PMC6250553 DOI: 10.1097/md.0000000000013130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Tendinitis of the longus colli muscle is an aseptic inflammatory process leading to acute posterior neck pain, neck stiffness, and dysphagia or odynophagia. We present a patient exhibiting an infrequent symptom, vertigo. This is the first description of the occurrence of vertigo symptoms caused by longus colli tendinitis. PATIENT CONCERNS A 38-year-old man was diagnosed with vertigo, presenting with a 1-month history of dizziness, palpitations, and numbness in the hands. DIAGNOSIS Longus colli tendinitis. The diagnosis was established using magnetic resonance imaging fat-suppression sequences. INTERVENTIONS Treatment with corticosteroid injections and acupotomy. OUTCOMES The symptoms relieved immediately after the treatment and complete resolution of the symptoms was observed after 1 week. LESSONS Longus colli tendinitis with vertigo is an under-reported condition in the literature and physicians should be aware of its existence. A lack of familiarity with the anatomy of the prevertebral space and its variable radiographic appearance makes the diagnosis of longus colli tendinitis clinically difficult. Misdiagnosis of this condition may lead to unnecessary interventions in vertigo.
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Affiliation(s)
- Yifeng Shen
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital
- Beijing University of Chinese Medicine, Beijing, China
| | - Qiaoyin Zhou
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital
- Beijing University of Chinese Medicine, Beijing, China
| | - Xinyue Zhu
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital
- Beijing University of Chinese Medicine, Beijing, China
| | - Zuyun Qiu
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital
- Beijing University of Chinese Medicine, Beijing, China
| | - Yan Jia
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital
- Beijing University of Chinese Medicine, Beijing, China
| | - Zixiang Liu
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital
- Beijing University of Chinese Medicine, Beijing, China
| | - Shiliang Li
- Department of acupuncture-moxibustion, China-Japan Friendship Hospital
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Alamoudi U, Al-Sayed AA, AlSallumi Y, Rigby MH, Taylor SM, Hart RD, Trites JRB. Acute calcific tendinitis of the longus colli muscle masquerading as a retropharyngeal abscess: A case report and review of the literature. Int J Surg Case Rep 2017; 41:343-346. [PMID: 29145108 PMCID: PMC5686463 DOI: 10.1016/j.ijscr.2017.10.063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/29/2017] [Accepted: 10/30/2017] [Indexed: 11/25/2022] Open
Abstract
The longus colli muscle is situated on the anterior surface of C1-C2 disk space. Calcific tendinitis of the longus colli muscle is a reactive self-limiting inflammatory response to the subacute deposition of calcium hydroxyapatite crystals on the tendon of the muscle. The clinical presentation is usually mistaken with other serious conditions, such as a retropharyngeal abscess, disk herniation, neck tumor or trauma. The importance of recognizing this pathology lies in preventing its misdiagnosis and mismanagement. This condition is usually managed conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs).
Introduction Acute calcific longus colli tendinitis, also known as retropharyngeal or acute calcific prevertebral tendinitis, is a reactive self-limiting inflammatory response to acute or subacute deposition of amorphous calcium hydroxyapatite crystals in the tendons of the longus colli muscle, anterior to the C1–C2 disk space. Case presentation A 53-year-old man presented with a complaint of neck pain and odynophagia over a few days. Blood test findings showed mild leukocytosis and elevated C-reactive protein level. Computed tomography findings showed mild edematous prevertebral thickening involving the retropharyngeal space, predominantly on the left side, with no appreciable surrounding peripheral enhancement. A small amount of linear calcification/ossification involving the superior fibers of the left longus colli muscle, anterior to the C1 arch were also noted. Discussion The patient’s presentation could be easily misdiagnosed as a retropharyngeal abscess. However, the presence of subtle findings on CT would lead to the correct diagnosis. The management of this condition is mainly with nonsteroidal anti-inflammatory drugs. Conclusion This study presents the characteristic radiological features of retropharyngeal calcific tendinitis. These features are subtle and could be missed. Once an accurate diagnosis is made, treatment with nonsteroidal anti-inflammatory drugs is indicated. The purpose of this case report is to highlight this rare condition’s diagnosis and management.
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Affiliation(s)
- Uthman Alamoudi
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada; Department of Otolaryngology, Hail University, Hail, Saudi Arabia.
| | - Ahmed A Al-Sayed
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada; Department of Otorhinolaryngology - Head & Neck Surgery, Department of Otolaryngology, King Saud University, Riyadh, Saudi Arabia
| | - Yasser AlSallumi
- Department of Radiology, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada; Department of Medical Imaging, Department of Radiology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Matthew H Rigby
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada
| | - S Mark Taylor
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada
| | - Robert D Hart
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada
| | - Jonathan R B Trites
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada
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Boardman J, Kanal E, Aldred P, Boonsiri J, Nworgu C, Zhang F. Frequency of acute longus colli tendinitis on CT examinations. Emerg Radiol 2017; 24:645-651. [PMID: 28744692 PMCID: PMC5681978 DOI: 10.1007/s10140-017-1537-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/11/2017] [Indexed: 11/26/2022]
Abstract
Purpose We attempted to determine the frequency of acute longus colli tendinitis on diagnostic CT imaging performed at a large multicenter health care system. By correlating with the pre-imaging clinical information, we investigated which patient presentations should lead the radiologist to increased suspicion for this condition. Methods Images from a total of 8101 adult CT examinations of the neck and cervical spine performed over a 3-month period were evaluated by researchers independent of the original clinical report. Clinical information available at the time of imaging was reviewed and assigned to one of five categories. Frequency of the condition was calculated by sex and clinical presentation. This retrospective study with waiver of consent and waiver of HIPPA was approved by our IRB. Results Nine positive scans were found for an overall frequency of 1.1 per 1000 examinations. The frequency was significantly higher (11.4 per thousand) on scans performed of patients presenting without history of recent trauma, concern for tumor, suspected postoperative complication, or clinical signs of infection localized to the neck. Although frequency in males was higher than in females, this did not reach statistical significance. In no positive or negative case was longus colli tendinitis considered in the pre-imaging documentation. Conclusions Findings of acute longus colli tendinitis on CT examination generally occur in the absence of prior mention of this condition in the medical record. The radiologist should be particularly alert for this diagnosis when a patient presents with rapid-onset neck pain without a clear history of recent trauma or other etiologies.
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Affiliation(s)
- John Boardman
- Radiology Suite, 201 East Wing, 200 Lothrop St, Pittsburgh, PA 15213 USA
| | - Emanuel Kanal
- Radiology Suite, 201 East Wing, 200 Lothrop St, Pittsburgh, PA 15213 USA
| | - Patrick Aldred
- Radiology Suite, 200 Lothrop St, Pittsburgh, PA 15213 USA
| | - Joseph Boonsiri
- Department of Neuroradiology, NYU, 660 First Ave., 2nd Floor, New York, NY 10016 USA
| | | | - Feng Zhang
- Department of Radiology Education, Stanford University Medical Center, 300 Pasteur Dr., H1330, MC:5621, Stanford, CA 94305-5621 USA
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14
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Naik PP, Poduval J, Divakaran S. Review Article: Retropharyngeal Abscess-Mimickers and Masqueraders. Indian J Otolaryngol Head Neck Surg 2017; 69:269-273. [PMID: 28607904 DOI: 10.1007/s12070-017-1105-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 02/21/2017] [Indexed: 12/19/2022] Open
Abstract
To discuss a case of suspected retropharyngeal abscess having important clinical and academic significance. This paper discusses an unusual presentation and evolution of a well known condition such as retropharyngeal abscess. Though the diagnosis in this case was initially a retropharyngeal abscess, several unusual findings were evident, which interfered with the optimal management of the patient. A literature review revealed rare causes and lesions mimicking a retropharyngeal abscess, such as retropharyngeal calcific tendinitis and Kawasaki disease, which are neither familiar to otolaryngologists nor other specialists such as orthopedicians. It is possible that this patient was both over treated and undertreated at the same time. Though the diagnosis in this case could not be established with certainty, several important pieces of information came up, especially unusual causes of retropharyngeal abscess and management of the same. Retropharyngeal abscess is a well-known condition with established modes of management. However, certain variations may occur and may pose challenges in diagnosis and management. These variations are little known and need to be highlighted so that optimal management is ensured.
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Affiliation(s)
- Paresh Pramod Naik
- Department of ENT, Pondicherry Institute of Medical Sciences, Kalapet, Ganapathychetikulam, Puducherry 605014 India
| | - Jayita Poduval
- Department of ENT, Pondicherry Institute of Medical Sciences, Kalapet, Ganapathychetikulam, Puducherry 605014 India
| | - Shilpa Divakaran
- Department of ENT, Pondicherry Institute of Medical Sciences, Kalapet, Ganapathychetikulam, Puducherry 605014 India
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Colella DM, Calderón Sandoval F, Powers DW, Patel N, Sobrado J. A Rare Cause of Dysphagia to Remember: Calcific Tendinitis of the Longus Colli Muscle. Case Rep Gastroenterol 2017; 10:755-759. [PMID: 28100997 PMCID: PMC5216232 DOI: 10.1159/000452199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/03/2016] [Indexed: 12/02/2022] Open
Abstract
Longus colli tendinitis (LCT) is an acute inflammatory condition with symptoms typically consisting of acute neck pain and stiffness with or without dysphagia. Once more severe etiologies for these symptoms are ruled out, this self-limiting condition usually resolves spontaneously with nonsteroidal anti-inflammatory drugs and corticosteroids. We present a case of LCT that presented as acute neck pain, dysphagia, and odynophagia that rapidly resolved once diagnosed and treated with anti-inflammatory agents. Though exceedingly rare, LCT must be considered in the differential diagnosis of acute neck pain, dysphagia, and odynophagia when more common etiologies do not correlate with the clinical presentation.
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Affiliation(s)
- Dominic M Colella
- Department of Gastroenterology, Larkin Hospital, Nova Southeastern University, South Miami, FL, USA
| | | | - David W Powers
- Department of Gastroenterology, Larkin Hospital, Nova Southeastern University, South Miami, FL, USA
| | - Nimal Patel
- Department of Gastroenterology, Larkin Hospital, Nova Southeastern University, South Miami, FL, USA
| | - Javier Sobrado
- Department of Gastroenterology, Larkin Hospital, Nova Southeastern University, South Miami, FL, USA
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16
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Joshi GS, Fomin DA, Joshi GS, Serano RD. Unusual case of acute neck pain: acute calcific longus colli tendinitis. BMJ Case Rep 2016; 2016:bcr-2016-216041. [PMID: 27257001 DOI: 10.1136/bcr-2016-216041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute calcific longus colli tendinitis (ACLCT), a very rare cause of severe neck pain, dysphagia and odynophagia, is often mistaken for other common causes of neck pain. However, prompt recognition of this uncommon presentation is important to prevent unnecessary medical and surgical intervention. A 46-year-old Caucasian man presented with a 1-day history of severe neck pain, headache and odynophagia. The patient was afebrile with stable vital signs, however, the laboratory data showed mildly elevated C reactive protein and erythrocyte sedimentation rate. The physical examination was remarkable for markedly reduced cervical range of motion. MRI revealed the pathognomonic findings of paravertebral oedema and calcification. The definitive diagnosis of ACLCT was made and the patient was successfully managed with a short course of oral steroid, benzodiazepine and aural acupuncture, with complete resolution of the condition within a week.
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Affiliation(s)
- Gunjan S Joshi
- Highland Neurology Center, Fayetteville, North Carolina, USA Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Daren A Fomin
- Highland Neurology Center, Fayetteville, North Carolina, USA Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Gargi S Joshi
- Highland Neurology Center, Fayetteville, North Carolina, USA
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Abstract
We present a case of neck pain in a middle-aged woman, initially attributed to a retropharyngeal infection and treated with urgent intubation. With the help of computed tomography, the diagnosis was later revised to acute prevertebral calcific tendinitis, a self-limiting condition caused by abnormal calcium hydroxyapatite deposition in the longus colli muscles. It is critical to differentiate between these two disease entities due to dramatic differences in management. A discussion of acute prevertebral calcific tendinitis and its imaging findings is provided below.
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Affiliation(s)
- Alexander Tamm
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Caroline C Jeffery
- Division of Otolaryngology - Head and Neck Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Khalid Ansari
- Division of Otolaryngology - Head and Neck Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Sandeep Naik
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, Alberta, Canada
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Calcific tendonitis of the longus colli muscle: a noninfectious cause of retropharyngeal fluid collection. Case Rep Otolaryngol 2014; 2014:286190. [PMID: 25506453 PMCID: PMC4260433 DOI: 10.1155/2014/286190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/12/2014] [Indexed: 11/25/2022] Open
Abstract
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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Chen CH, Lu YC, Wong TY. Acute calcific prevertebral tendinitis: rare cause of neck pain. Acute Med Surg 2014; 2:199-201. [PMID: 29123721 DOI: 10.1002/ams2.92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/17/2014] [Indexed: 11/10/2022] Open
Abstract
Case We report a case of acute calcific prevertebral tendinitis and discuss the clinical signs, symptoms, and radiologic findings of the disease. Outcome This 47-year-old man suffered from neck pain, odynophagia, and sore throat for 2 days. Acute calcific prevertebral tendinitis was noted. This disease, brought on by prolonged minor repetitive tendon injury, is an often overlooked cause of acute neck pain. The typical radiologic appearances of the disease include the calcification of the anterior surface of the C1-C2 spine and smooth soft tissue swelling over the retropharyngeal space. Conclusion Generally this disease is benign and may be misdiagnosed as deep neck infection. Drainage on this patient would be considered malpractice.
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Affiliation(s)
- Chia-Hsi Chen
- Department of Emergency Medicine St. Martin De Porres Hospital Chiayi Taiwan
| | - Ying-Chou Lu
- Department of Otolaryngology St. Martin De Porres Hospital Chiayi Taiwan
| | - Tak-Yee Wong
- Department of Diagnostic Radiology St. Martin De Porres Hospital Chiayi Taiwan
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Acute severe neck pain and dysphagia following cervical maneuver: diagnostic approach. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 131:135-8. [PMID: 23845292 DOI: 10.1016/j.anorl.2013.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 03/13/2013] [Accepted: 03/19/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Overlooking an etiologic hypothesis in acute neck pain with dysphagia may lead to misdiagnosis. CASE REPORT A 51-year-old man who had received cervical manipulation came to the emergency unit with evolutive acute neck pain, cervical spine stiffness and odynophagia, without fever or other signs of identified pathology. Cervical X-ray and CT angiography of the supra-aortic vessels ruled out traumatic etiology (fracture or arterial dissection) and revealed an accessory bone, orienting diagnosis toward retropharyngeal abscess, which was, however, belied by endoscopy performed under general anesthesia. A second CT scan with contrast injection and tissue phase ruled out infection, revealing a retropharyngeal calcification inducing retropharyngeal edema. Evolution under analgesics was favorable within 13 days. DISCUSSION Given a clinical triad associating acute neck pain, cervical spine stiffness and odynophagia, traumatic or infectious etiology was initially suspected. Cervical CT diagnosed calcific tendinitis of the longus colli, revealing a pathognomic retropharyngeal calcification. Secondary to hydroxyapatite deposits anterior to the odontoid process of the axis, this is a rare form of tendinopathy, usually showing favorable evolution in 10-15 days under analgesic and anti-inflammatory treatment.
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Retropharyngeal calcific tendinitis mimicking a retropharyngeal phlegmon. Case Rep Otolaryngol 2013; 2013:912628. [PMID: 23862089 PMCID: PMC3686063 DOI: 10.1155/2013/912628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 04/30/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Acute retropharyngeal tendinitis is a little known but not an uncommon condition. It was first described by Hartley in 1964 as an inflammation of the longus colli muscle secondary to calcium crystals deposition on its insertion. The calcifications are mostly located on the oblique portion of the muscle at the level of C1-C2. Methods. We will describe this disease through 4 cases that presented in our institution. Results. The most common symptoms are severe neck pain, odynophagia, and a painful restriction of neck movement. It is associated with mild fever and inflammatory lab findings such as a slight elevation of white blood cell count, erythrocyte sedimentation rate, and C-reactive protein. CT scan is recommended as the first-line imaging modality to establish a diagnosis. Treatments consist of NSAIDs and analgesics to accelerate the healing process. If symptoms are severe, a course of corticosteroids is required. Conclusion. Since the clinical and laboratory findings of this condition and those of a retropharyngeal abscess overlap, it is important to establish the right diagnosis in order to prevent more invasive procedures. A good knowledge of this clinical entity by otolaryngologists would prevent delays in hospital discharge and unnecessary anxiety.
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Hammer GP, Vollmann R, Tomazic PV, Simbrunner J, Friedrich G. Prevertebral tendinitis: how to avoid unnecessary surgical interventions. Laryngoscope 2012; 122:1570-4. [PMID: 22549265 DOI: 10.1002/lary.23338] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 03/06/2012] [Accepted: 03/12/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Prevertebral tendinitis is an inflammatory process that affects the cervicothoracic prevertebral muscles. Because of its clinical presentation and imaging features in computed tomography scans, prevertebral tendinitis can easily be mistaken for deep cervical abscess formation. Totally different therapy regimens require clinical and diagnostic pathways for sufficient differentiation between those two pathologic entities. STUDY DESIGN Case series with comparison. METHODS In 10 patients with prevertebral tendinitis, we evaluated the symptoms, laboratory reports, and radiological imaging findings. We compared these data to 65 patients with a deep cervical abscess formation. The basic radiologic imaging procedure was contrast-enhanced computed tomography. For detection of prevertebral tendinitis, we performed magnetic resonance imaging with diffusion-weighted images and calculated the apparent diffusion coefficient map. RESULTS Patients with prevertebral tendinitis complained of severe neck pain, globus sensation, and neck stiffness. Diffusion-weighted images showed a typical benign prevertebral effusion. Computed tomography scans showed amorphous calcifications in the tendon of the prevertebral muscles. The C-reactive protein values were slightly increased in patients with prevertebral tendinitis, and white blood cell count remained normal. In comparison to patients with deep cervical abscess formation, the C-reactive protein and white blood cell count was significantly lower (P < .05) in the prevertebral tendinitis cases. CONCLUSIONS Prevertebral tendinitis should be considered when patients suffer from neck pain, neck stiffness, and globus sensations despite low signs of inflammation in the laboratory report. To confirm the diagnosis, the best imaging feature is magnetic resonance imaging with diffusion-weighted images and apparent diffusion coefficient map.
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Grassi CG, Diniz FDV, Garcia MRT, Gomes RLE, Daniel MM, Funari MBDG. Aspectos de imagem na tendinite calcária pré-vertebral. Radiol Bras 2011. [DOI: 10.1590/s0100-39842011000500012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A tendinite calcária aguda pré-vertebral é uma condição benigna e rara que apresenta calcificação das fibras do músculo longo do pescoço com reação inflamatória local, sendo esta uma das formas de apresentação menos frequentes da doença por deposição de hidroxiapatita de cálcio. Manifesta-se com dor cervical aguda e/ou odinofagia, podendo ser erroneamente diagnosticada como abscesso retrofaríngeo, espondilodiscite ou alteração decorrente de trauma. Os achados radiológicos na tendinite calcária pré-vertebral são patognomônicos. O conhecimento de tais achados é muito importante, pois o correto diagnóstico possibilita a resolução precoce dos sintomas e evita intervenções desnecessárias em um paciente que apresenta afecção com boa resposta ao tratamento conservador.
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A Severe Sore Throat in a Middle-Aged Man: Calcific Tendonitis of the Longus Colli Tendon. J Emerg Med 2011; 41:151-3. [DOI: 10.1016/j.jemermed.2008.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 01/11/2008] [Accepted: 01/17/2008] [Indexed: 11/21/2022]
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Lee S, Joo KB, Lee KH, Uhm WS. Acute retropharyngeal calcific tendinitis in an unusual location: a case report in a patient with rheumatoid arthritis and atlantoaxial subluxation. Korean J Radiol 2011; 12:504-9. [PMID: 21852912 PMCID: PMC3150679 DOI: 10.3348/kjr.2011.12.4.504] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 12/29/2010] [Indexed: 11/23/2022] Open
Abstract
Retropharyngeal calcific tendinitis is defined as inflammation of the longus colli muscle and is caused by the deposition of calcium hydroxyapatite crystals, which usually involves the superior oblique fibers of the longus colli muscle from C1-3. Diagnosis is usually made by detecting amorphous calcification and prevertebral soft tissue swelling on radiograph, CT or MRI. In this report, we introduce a case of this disease which was misdiagnosed as a retropharyngeal tuberculous abscess, or a muscle strain of the ongus colli muscle. No calcifications were visible along the vertical fibers of the longus colli muscle. The lesion was located anterior to the C4-5 disc, in a rheumatoid arthritis patient with atlantoaxial subluxation. Calcific tendinitis of the longus colli muscle at this location in a rheumatoid arthritis patient has not been reported in the English literature.
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Affiliation(s)
- Seunghun Lee
- Department of Radiology, Hanyang University Hospital, 17 Haengdang-dong, Sungdong-gu, Seoul, Korea
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Benign febrile cervicalgia due to calcific retropharyngeal tendinitis: case study. Orthop Traumatol Surg Res 2011; 97:341-4. [PMID: 21458398 DOI: 10.1016/j.otsr.2010.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 07/14/2010] [Accepted: 09/06/2010] [Indexed: 02/02/2023]
Abstract
Periarticular calcific tendinopathy has been well described, but no retropharyngeal locations have been reported in the surgical orthopedic literature. This pathology is a diagnostic pitfall, leading to fruitless invasive examinations and treatment. The clinical aspect is misleading, but pathognomic imaging can establish diagnosis. We report a case of febrile postoperative cervicalgia, initially suggestive of a septic complication, but in which imaging indicated retropharyngeal calcific tendinitis.
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Vollmann R, Hammer G, Simbrunner J. Pathways in the diagnosis of prevertebral tendinitis. Eur J Radiol 2011; 81:114-7. [PMID: 21439752 DOI: 10.1016/j.ejrad.2011.02.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 02/12/2011] [Accepted: 02/24/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The prevertebral tendinitis is an inflammatory process, which affects the cervicothoracic prevertebral muscles. This extremely rare entity was first described by Hartley and Fahlgren in 1964 and until now there are just some case reports dealing with this process. Unfortunately it is quite easy to misdiagnose or mistake the prevertebral tendinitis as an abscess, because of the imaging features. The aim of this case series is to offer guidelines in the diagnosis of this rare disease to prevent unnecessary surgery. MATERIAL AND METHODS Six patients with already by imaging or retrospectively after surgery by pathologic report diagnosed prevertebral tendinitis were included in this study. None of these patients suffered from a chronically inflammatory disease. Three patients just received contrast enhanced computed tomography (CT) and another group of three patients received magnetic resonance imaging (MRI). In two out of three MRI examinations, we additionally performed diffusion weighted images and calculated the apparent diffusion coefficient (ADC) map. The laboratory reports obtained on the day of the computed tomography (CT) or magnetic resonance imaging (MRI) examinations were reviewed for C-reactive protein (CRP) and white blood cell count (WBCC). RESULTS All patients revealed a prevertebral cervical effusion. Five out of six patients showed amorphous calcifications in the tendon of the prevertebral muscles. In one case calcifications could not be identified at all because of very strong beam hardening artefacts caused by dental prothesis. The CRP values were increased in all patients (mean value 44.9 mg/l; SD ± 28.3). However, WBCC remained normal (mean value 8.4G/l; SD ± 2.7). Only for the two patients who received DWI it was possible to assess the quality of the prevertebral fluid accumulation and to detect the benign prevertebral effusion, which is typical for the retropharyngeal tendinitis. CONCLUSION According to the experience with our patients the best imaging feature is MRI with DWI and ADC map to reveal the benign prevertebral effusion and confirm the diagnosis of prevertebral tendinitis. In some cases MRI might not be available. Here we recommend CT scans to detect typical prevertebral calcifications. Especially a slight elevation of CRP and normal WBCC make the prevertebral tendinitis more likely.
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Affiliation(s)
- R Vollmann
- Medical University Graz, Department of Radiology, Auenbruggerplatz 9, 8036 Graz, Austria.
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Park R, Halpert DE, Baer A, Kunar D, Holt PA. Retropharyngeal Calcific Tendinitis: Case Report and Review of the Literature. Semin Arthritis Rheum 2010; 39:504-9. [DOI: 10.1016/j.semarthrit.2009.04.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Revised: 04/27/2009] [Accepted: 04/29/2009] [Indexed: 11/24/2022]
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OFFIAH CE, HALL E. Acute calcific tendinitis of the longus colli muscle: spectrum of CT appearances and anatomical correlation. Br J Radiol 2009; 82:e117-21. [DOI: 10.1259/bjr/19797697] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Retropharyngeal Tendinitis May be More Common Than We Think: A Report on 45 Cases Seen in Danish Chiropractic Clinics. J Manipulative Physiol Ther 2009; 32:315-20. [DOI: 10.1016/j.jmpt.2009.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 12/16/2008] [Indexed: 11/18/2022]
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Ellika SK, Payne SC, Patel SC, Jain R. Acute calcific tendinitis of the longus colli: an imaging diagnosis. Dentomaxillofac Radiol 2008; 37:121-4. [DOI: 10.1259/dmfr/23211511] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kupferman TA, Rice CH, Gage-White L. Acute Prevertebral Calcific Tendinitis: A Nonsurgical Cause of Prevertebral Fluid Collection. EAR, NOSE & THROAT JOURNAL 2007. [DOI: 10.1177/014556130708600314] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Calcific tendinitis of the prevertebral muscles is a rare clinical entity. Its nonspecific presenting symptoms (e.g., retropharyngeal space infection) may mimic an infectious etiology. Treatment is based on the administration of a nonsteroidal anti-inflammatory drug (NSAID) for 2 to 3 weeks and cessation of symptom-provoking activity. Most patients will improve greatly within the first 48 to 72 hours after the initiation of an NSAID, and complete resolution generally occurs within 3 weeks. We describe a new case of prevertebral calcific tendinitis, and we review the literature on this condition.
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Affiliation(s)
- Todd A. Kupferman
- From the Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport
| | - Clifford H. Rice
- From the Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport
| | - Linda Gage-White
- From the Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport
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Kusunoki T, Muramoto D, Murata K. A case of calcific retropharyngeal tendinitis suspected to be a retropharyngeal abscess upon the first medical examination. Auris Nasus Larynx 2006; 33:329-31. [PMID: 16439087 DOI: 10.1016/j.anl.2005.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Revised: 10/03/2005] [Accepted: 11/11/2005] [Indexed: 11/23/2022]
Abstract
We report a case of calcific retropharyngeal tendonitis that was difficult to distinguish from retropharyngeal abscess. The patient was a 34-year-old woman who complained of severe cervical pain and stiffness for 1 day. She had a fever and moderately elevated WBC. Fine needle aspiration of the swollen region of the retropharyngeal wall could not elucidate the pus characteristics. Enhanced CT scan showed no signs of an abscess, but clearly showed calcifications in front of the C1-2 cervical spine. An emergency drainage operation was avoided, and the patient fully recovered after treatment with NSAIDs and steroids.
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Affiliation(s)
- Takeshi Kusunoki
- Department of Otolaryngology, Kinki University School of Medicine, Osakasayama, Osaka 589-8511, Japan.
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Chung T, Rebello R, Gooden EA. Retropharyngeal calcific tendinitis: case report and review of literature. Emerg Radiol 2005; 11:375-80. [PMID: 16344978 DOI: 10.1007/s10140-005-0427-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Accepted: 05/18/2005] [Indexed: 11/30/2022]
Abstract
Retropharyngeal calcific tendinitis, also known as acute calcific prevertebral tendinitis or longus colli tendinitis, is an uncommon benign condition presenting as acute neck pain. Clinically, it can be misdiagnosed as retropharyngeal abscess, traumatic injury, or infectious spondylitis. The diagnosis is made radiographically by an amorphous calcification anterior to C1-C2 and prevertebral soft tissue swelling. We present three cases of this uncommon condition to illustrate the classic findings on plain film, CT, and MRI. Recognition of the pathognomonic imaging appearance allows for easy diagnosis preventing unnecessary tests and treatment.
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Affiliation(s)
- Terry Chung
- Department of Radiology, St Joseph's Hospital, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.
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Ring D, Vaccaro AR, Scuderi G, Pathria MN, Garfin SR. Acute calcific retropharyngeal tendinitis. Clinical presentation and pathological characterization. J Bone Joint Surg Am 1994; 76:1636-42. [PMID: 7962023 DOI: 10.2106/00004623-199411000-00006] [Citation(s) in RCA: 118] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Acute calcific retropharyngeal tendinitis is an underrecognized cause of pain and stiffness in the neck associated with odynophagia and retropharyngeal soft-tissue swelling. We report on five patients in whom an initial misdiagnosis of this entity as a retropharyngeal or nasopharyngeal abscess, a neoplasm, or a fracture-dislocation of the cervical spine led to interventions such as admission to the hospital and parenteral administration of antibiotics. An open biopsy was performed in one patient because of a suspected neoplasm. Evaluation of the tissue specimen with routine and polarized light microscopy, scanning electron microscopy, and energy-dispersive spectrometry demonstrated a foreign-body inflammatory response to deposited crystals of hydroxyapatite. In all five patients, the correct diagnosis was established only after retrospective review of the radiographic studies by a physician who was familiar with acute calcific retropharyngeal tendinitis. The computed tomographic findings of acute calcific retropharyngeal tendinitis are distinctive and consist of prevertebral calcification localized to the insertion of an edematous tendon of the longus colli muscle. Symptomatic relief was provided with anti-inflammatory and analgesic medications. The symptoms resolved, without sequelae, within one to two weeks for all of the patients. We hope that an increased awareness of hydroxyapatite deposition in the tendon of the longus colli muscle will result in improved early diagnosis of acute calcific retropharyngeal tendinitis.
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Affiliation(s)
- D Ring
- University of California at San Diego
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Ekbom K, Torhall J, Annell K, Träff J. Magnetic resonance imaging in retropharyngeal tendinitis. Cephalalgia 1994; 14:266-9; discussion 257. [PMID: 7954754 DOI: 10.1046/j.1468-2982.1994.1404266.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Seven consecutive patients with acute retropharyngeal tendinitis underwent plain X-ray and magnetic resonance imaging (MRI) of the cervical spine. All seven had marked soft tissue swelling anterior to C1 and C2 on plain X-ray, and soft tissue calcification at this level was present in five of them. On MRI, there was markedly increased signal intensity on T2-weighted images in the acute phase and intermediate signal intensity on T1-weighted images, anterior to the level of C1 and C2, often extending as far down as C6. These changes correlated well with the soft tissue swelling seen on conventional X-ray of the cervical spine. The maximum mid-sagittal thickness of the soft tissues was significantly greater in the tendinitis patients (p < 0.001) than in 12 control subjects free of symptoms from the pharynx or the cervical spine. Treatment with non-steroidal anti-inflammatory drugs rapidly alleviated symptoms, and at follow-up MRI showed regression or complete restitution of the changes. In conclusion, MRI can visualize the edematous changes in the longus colli muscle and adds useful diagnostic information in suspected cases of acute retropharyngeal tendinitis.
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Affiliation(s)
- K Ekbom
- Department of Neurology, Söder Hospital, Stockholm, Sweden
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Affiliation(s)
- T Figler
- Department of Radiology, Loyola University Medical Center, Maywood, Ill 60153
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40
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Artenian DJ, Lipman JK, Scidmore GK, Brant-Zawadzki M. Acute neck pain due to tendonitis of the longus colli: CT and MRI findings. Neuroradiology 1989; 31:166-9. [PMID: 2664554 DOI: 10.1007/bf00698847] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Calcific retropharyngeal tendonitis is an under-recognized cause of acute cervical pain produced by inflammation of the longus colli muscle. Although the clinical presentation may mimic more serious disorders, the diagnosis can be established radiographically by identification of prevertebral soft tissue calcification and swelling. Six patients with typical signs and symptoms of retropharyngeal tendonitis are presented. All were evaluated with plain films, four with CT and one with MRI. The pathognomonic finding of amorphous calcification anterior to C1-2 with associated asymmetric soft tissue swelling was clearly demonstrated by CT. Diffuse swelling of the longus colli muscle was shown as prominent high signal in the prevertebral region by T2 weighted MRI.
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Affiliation(s)
- D J Artenian
- Department of Radiology, Hoag Memorial Hospital Presbyterian, Newport Beach, California
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Abstract
Retropharyngeal tendinitis is a rare but underdiagnosed disorder. The clinical picture is characterized by increasingly severe pain in the upper neck occurring within 1 or 2 days and with pain aggravated by swallowing and head movements. Acute-phase roentgenograms show substantial soft-tissue swelling anterior to the vertebral bodies, C1 to C4, often accompanied by amorphous calciferous deposition below the anterior tubercle of the atlas. The course is benign, the patient being asymptomatic after 1 or 2 weeks. I briefly describe three cases which were characterized by severe pain in the mid-cervical spine and radiologic findings of soft-tissue swelling anterior to the vertebral bodies, C2-C6. These cases were probably due to acute tendinitis of the longus colli muscle, although located at a lower level than in previously reported cases of retropharyngeal tendinitis.
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Affiliation(s)
- H Fahlgren
- Department of Neurology, Söder Hospital, Stockholm, Sweden
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Abstract
A rare clinical syndrome, with acute onset of severe pains localized in the back of the neck and aggravated by head movements and swallowing, has been studied in 28 patients. X-ray examinations of the cervical spine and prevertebral soft tissues in straight lateral projection of all patients in the acute phase showed significant soft-tissue swelling anterior to the vertebral bodies of C1-C4. Eighteen patients had an amorphous calcific deposit below the tuberculum anterius atlantis in or near the mid-line. The clinical symptoms were characteristic, with a benign course and freedom from complaints and regression of the radiological changes after 1-2 weeks. The diagnosis was usually made clinically and confirmed after two or more X-ray examinations of the cervical spine and the prevertebral soft tissues. The disease was in all probability caused by acute tendinitis in the longus colli musculus.
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Benanti JC, Gramling P, Bulat PI, Chen P, Lundstrom G. Retropharyngeal calcific tendinitis: report of five cases and review of the literature. J Emerg Med 1986; 4:15-24. [PMID: 3461065 DOI: 10.1016/0736-4679(86)90108-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Retropharyngeal calcific tendinitis is an inflammation of the longus colli muscle tendon, which is located on the anterior surface of the vertebral column extending from the atlas to the third thoracic vertebra. Five cases of acute retropharyngeal calcific tendinitis seen in the emergency department (ED) over a 15-month period are reported. In addition, a retrospective review of four cases diagnosed as retropharyngeal abscess and admitted to the hospital revealed that two of these cases actually represented retropharyngeal calcific tendinitis. A review of the literature and potential differential diagnoses are presented. For those primary care physicians who must evaluate patients with acute cervical pain, sore throat, or odynophagia, an x-ray study of the neck revealing retropharyngeal calcium deposition should raise the question of the diagnosis of acute retropharyngeal tendinitis. Clinical characteristics of this entity include a painful condition which is treatable and is often mistaken for retropharyngeal abscess, pharyngitis, or peritonsillar abscess. In our opinion, this condition may be more prevalent than the literature suggests.
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