Acute Calcific Tendinitis Of Longus Colli Research Articles

Severe neck pain and odynophagia\xa0secondary to\xa0acute calcific longus colli tendinitis: a case report

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.

A Rare Case of Neck Pain: Acute Longus Colli Calcific Tendinitis in a Possibly Immunocompromised Individual

We present a rare case of severe neck pain in a 45-year-old man with severe hidradenitis suppurativa who was participating in a study involving adalimumab. The neck pain was associated with acute longus colli calcific tendinitis, which is a noninfectious inflammatory response in the longus colli tendons secondary to deposition of calcium hydroxyapatite crystal. The diagnosis was made by computed tomography, which showed calcifications and deposits, and magnetic resonance imaging, which showed a retropharyngeal effusion. Ears, Nose, and Throat Services performed a fiberoptic scope examination, which revealed a patent airway and no drainable abscess. Nonsteroidal anti-inflammatory drugs resulted in a dramatic improvement in the patient's clinical symptoms. In acute longus colli tendinitis, differentiating retropharyngeal aseptic effusion from infection is important. Of note, the confounding factor in this case was that the patient was blinded to whether he was receiving the placebo or adalimumab, so whether the patient was immunosuppressed and at risk for infection was unknown. Clinician familiarity and education concerning acute calcific longus colli tendinitis may lead to decreased costs stemming from incorrect diagnosis and unnecessary treatment.

Acute Calcific Longus Colli Tendinitis: An Underdiagnosed Cause of Neck Pain and Dysphagia

Etiologies for neck pain are multiple but those associated with dysphagia remain limited to retropharyngeal abscess, soft tissue swellings, trauma, oro-pharyngeal neoplasms and acute calcific longus colli tendinitis. Acute calcific longus colli tendinitis is an inflammation of the longus colli tendon that manifests with acute onset of neck pain that is often associated with torticollis and when more advanced, with dysphagia or odynophagia. We present a 39 year old woman who developed acute onset of neck pain that over the next few days progressed to involve dysphagia. Multiple imaging studies were performed that eventually supported the diagnosis of acute calcific longus colli tendinitis. We would like to raise awareness of acute calcific longus colli tendinitis as an often under-diagnosed cause of acute neck pain.

Acute Calcific Longus Colli Tendinitis

Acute calcific longus colli tendinitis (LCT) has been reported as an unusual cause of acute-onset neck pain, dysphagia, and headache.(1-5) As described in most of the published reports, LCT traditionally manifests on computed tomography (CT) imaging as paramidline calcium hydroxyapatite crystal deposits anterior to the C1 and C2 vertebral bodies. However, recent studies have brought attention to the disease existing at the C4-C5 and C5-C6 levels.(6,7) Acute LCT is considered relatively benign, typically resolving on its own within several weeks.