Abstract
BackgroundAcute calcific longus colli tendinitis is a rare, noninfectious inflammatory condition caused by the deposition of calcium crystals. The condition is self-limiting, yet commonly misdiagnosed. Here we report a case of a patient with severe neck pain and odynophagia initially misdiagnosed as a retropharyngeal abscess before establishing the correct diagnosis of acute calcific longus colli tendinitis.Case presentationA 60-year-old Caucasian man presented to an outside emergency department with a 5-day history of neck pain and odynophagia. The neck pain was severe and aggravated by movement. Laboratory evaluation revealed leukocytosis and elevated C-reactive protein. Computed tomography of his neck soft tissues was initially interpreted as a retropharyngeal abscess. Antibiotic therapy with piperacillin/tazobactam was initiated, and the patient was transferred to our tertiary care center for further evaluation and treatment. On physical examination, the patient’s neck range of motion was significantly diminished, and bilateral neck tenderness was present. An otolaryngologist performed an examination with laryngoscopy, the result of which was unremarkable. A radiologist at our facility interpreted his outside magnetic resonance imaging as showing “calcification in the prevertebral muscles at C1-C2, inflammation with edema of the prevertebral muscles, and retropharyngeal space edema/effusion,” consistent with acute calcific longus colli tendinitis. His antibiotics were discontinued, and he was started on intravenous ketorolac. He had significant improvement in his neck range of motion, and his pain diminished greatly. He was discharged on a 10-day course of diclofenac (50 mg three times daily). At 1-week follow-up, the patient was doing well; he had returned to work, and his pain was well controlled.ConclusionsThis case report details the presentation, characteristic radiographic findings, and management of a patient with an extremely rare condition of neck pain and odynophagia that could be treated with nonsteroidal anti-inflammatory drugs.
Highlights
Acute calcific longus colli tendinitis is a rare, noninfectious inflammatory condition caused by the deposition of calcium crystals
This case report details the presentation, characteristic radiographic findings, and management of a patient with an extremely rare condition of neck pain and odynophagia that could be treated with nonsteroidal antiinflammatory drugs
Case presentation A 60-year-old Caucasian man with a past medical history significant for hypertension, obstructive sleep apnea, tobacco use, solitary pulmonary nodule, and hyperlipidemia presented to the emergency department as a transfer from an outside facility for further evaluation of neck pain concerning for retropharyngeal abscess based on imaging and clinical presentation
Summary
Acute calcific longus colli tendinitis is a noninfectious inflammatory process secondary to the “deposition of amorphous calcium hydroxyapatite crystals in the tendons of the longus colli muscle,” most commonly anterior to the C1–C2 vertebral level [1]. Case presentation A 60-year-old Caucasian man with a past medical history significant for hypertension, obstructive sleep apnea, tobacco use, solitary pulmonary nodule, and hyperlipidemia presented to the emergency department as a transfer from an outside facility for further evaluation of neck pain concerning for retropharyngeal abscess based on imaging and clinical presentation. CT of the neck soft tissue was initially interpreted as showing a 1.1 × 5.6–cm retropharyngeal abscess with enlarged palatine tonsils, and subsequent magnetic resonance imaging (MRI) initially confirmed a 1 × 7.1 × 3.2– cm prevertebral abscess He was started on piperacillin/ tazobactam and was administered 6 mg of morphine intravenously, followed 2 hours later by 100 μg of fentanyl intravenously. He had significant improvement in neck range of motion in all directions, and his pain diminished greatly He was discharged on a 10-day course of oral diclofenac 50 mg three times daily.
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