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.
This condition typically occurs in adults in middle age (20-50 years of age) with a slight predilection for females 3.
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 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.
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 the 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 localised marrow signal inflammatory has been reported 1,2.
- 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
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
- 3. Kerlie Estimable, Cynthia Rizk, George G. A. Pujalte. A Rare Case of Neck Pain: Acute Longus Colli Calcific Tendinitis in a Possibly Immunocompromised Individual. The Journal of the American Board of Family Medicine. 28 (1): 146. doi:10.3122/jabfm.2015.01.140124 - Pubmed