A Rare Cause of Dysphagia to Consider: Calcific Tendinitis of the Longus Colli Muscle

Abstract

Calcific tendinitis of the longus colli muscle is an acute inflammatory condition caused by the deposition of calcium hydroxyapatite crystals in the muscle's superior insertion point. It is a rare condition with a reported incidence of 1.31 per 100,000 person-years that most commonly presents during the third through sixth decades of life. Symptoms consist of acute neck pain characterized as stiffness with associated odynophagia; the condition is less frequently associated with dysphagia. A mild leukocytosis is typically present, which should prompt investigation to rule out other infectious etiologies first. Characteristic radiographic findings include calcifications in the superior fibers of the longus colli muscle tendons at the level of C1 or C2. This self-limiting condition usually resolves spontaneously with nonsteroidal anti-inflammatory agents. A 44-year old female patient with a medical history of gastroesophageal reflux disease, gastric ulcers, gastritis, gastric polyps, Schatzki ring, hiatal hernia, and benign thyroid nodules presented to the hospital with the complaint of progressive dysphagia to solid foods. This dysphagia developed after an isolated incident of food aspiration four weeks prior to her presentation. Three weeks after this event, she experienced persistent odynophagia with associated left-sided occipital headaches and neck pain radiating to the left ear and mastoid process. Physical examination was remarkable for decreased range of motion with neck flexion and extension, bilateral neck soft tissue tenderness to palpation, and thyromegaly. Laboratory data revealed a hemoglobin of 11.5, hematocrit of 34.8, and WBC of 11.88. An upper gastrointestinal series with barium swallow confirmed the presence of the patient's known Schatzki ring and hiatal hernia. A CT scan, MRI, and MRA of the brain was negative for acute abnormalities, however the CT scan of her neck was positive for calcified longus colli tendons just below the anterior ring of the C1 vertebrae. After an infectious etiology was ruled out, she underwent a trial of oral corticosteroids and NSAIDs that quickly improved her dysphagia and odynophagia. Though exceedingly rare, calcific tendinitis of the longus colli muscle must be considered in a differential diagnosis once the more common etiologies of acute dysphagia and odynophagia have been ruled out or do not correlate with the clinical presentation and/or patient's history. Since this patient's symptoms were progressive, persistent, and associated with a decreased range of motion in her neck along with soft tissue tenderness to palpation, her symptoms were not solely due to the presence of a Schatzki ring. These symptoms did indeed support the final diagnosis of calcific tendinitis of the longus colli muscle.