Calcific tendinitis of the longus colli muscle
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Calcific tendinitis of the longus colli muscles is an inflammatory/granulomatous response to the deposition of calcium hydroxyapatite crystals in the tendons of the longus colli muscle. It is sometimes more generically known as calcific prevertebral tendinitis or, less accurately, as retropharyngeal calcific tendinitis.
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Like other forms of calcific tendinitis, this condition typically occurs in adults in middle age (20-50 years old) 3. There is no consistent gender predilection across case series 4.
In a retrospective review of adult neck and cervical spine CTs in one American health system, the frequency of acute longus colli tendinitis was 1 in 1000 examinations 4.
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. White blood cell count and erythrocyte sedimentation rate 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 fibers of the longus colli muscle tendons (at the C1-C2 level) 1-3. Occasionally the inferior fibers may be affected, as low down as T3. The longus colli muscles may also appear hypo-attenuating due to edema.
Small retropharyngeal effusions and edema of the adjacent prevertebral soft tissues are also usually seen.
Importantly, enhancement around the effusion is usually minimal and if present, should shift the diagnosis towards a retropharyngeal abscess 3. Adenopathy and bone destruction, likewise, should suggest alternative diagnosis 1-3.
MRI will easily demonstrate edema; however, a high level of suspicion is needed as the calcifications are much harder to visualize.
As is the case with CT, the presence of peripheral enhancement and/or suppurative lymphadenopathy should suggest infection as the underlying cause 2,3.
At least one case of localized marrow signal inflammatory has been reported 1,2.
Treatment and prognosis
Conservative management with NSAIDs is generally all that is required. Symptoms tend to resolve within a few weeks.
In some cases, along with resolution of the fluid, the mineralization can be reabsorbed and will not be evident on follow up imaging 5,6.
- prominent surrounding enhancement
- diffusion restricting fluid within the collection
- cervical lymphadenopathy
- prevertebral bone fragments from acute fractures may be mistaken for calcification in the longus colli tendons
- soft tissue mass
- contrast enhancement
- cervical lymphadenopathy
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