Calcific tendinitis of the longus colli muscle is an inflammatory/granulomatous response to deposition of calcium hydroxyapatite crystals in the tendons of the longus colli muscle.
Patients can present with debilitating symptoms that are unrelated to the degree of calcification seen on CT. Symptoms develop acutely and include neck pain, fever, dysphagia, odynophagia and reduced neck range of movement. WCC and ESR may be elevated.
Plain radiograph and CT
Calcifications may be seen on radiographs, but the preferred imaging modality is contrast-enhanced CT. On CT, amorphous calcifications are typically seen in the superior fibres of the longus colli muscle tendons (at the C1-C2 level). Occasionally the inferior fibres may be affected, as low down as T3. Small retropharyngeal effusions and oedema of the adjacent prevertebral soft tissues are also usually seen. Enhancement around the effusion should shift the diagnosis towards an abscess. Adenopathy and bone destruction, likewise, should suggest alternative diagnosis.
MRI will demonstrate the oedema, but is not as distinct with the calcifications. At least one case of localised marrow signal inflammatory has been reported.
- retropharyngeal abscess: should have cervical lymphadenopathy
- trauma: prevertebral bone fragments from acute fractures may be mistaken for calcification in the longus colli tendons
- tumour: should have a soft tissue mass, contrast enhancement or cervical lymphadenopathy
Treatment and prognosis
Conservative management with NSAIDs is generally all that is required. Symptoms tend to resolve within a few weeks.
- 1. Offiah CE, Hall E. Acute calcific tendinitis of the longus colli muscle: spectrum of CT appearances and anatomical correlation. Br J Radiol. 2009;82 (978): e117-21. doi:10.1259/bjr/19797697 - Pubmed citation
- 2. Eastwood JD, Hudgins PA, Malone D. Retropharyngeal effusion in acute calcific prevertebral tendinitis: diagnosis with CT and MR imaging. AJNR Am J Neuroradiol. 1999;19 (9): 1789-92. Pubmed citation