12th May 2017, Volume 130 Number 1455

Michael Plunkett, Hugh De Lautour, Adam Worthington

A 35-year-old female presented with a two-day history of severe neck pain and stiffness—particularly on the left—and moderate odynophagia. She had no history of fevers or trauma. She had tenderness on palpation of left cervical paraspinal tissue posteriorly, and marked limitation of cervical spine motion. White blood cell count was 15.5x10^9/L and C-reactive protein was 88mg/L (0–5mg/L). Cervical spine radiograph showed an area of calcification measuring 13x6mm within the prevertebral tissue anterior to C2 (Panel A, arrow) and prevertebral soft tissue swelling superiorly. Computed tomography (CT) of the neck revealed an amorphous focus of calcification within the left longus coli muscle anterior to the C2 vertebral body (Panels B and C, arrows), with associated simple fluid within the prevertebral space (Panel D, arrow).

Acute calcific tendinitis of the longus colli muscle was diagnosed. An oral non-steroidal anti-inflammatory was started and symptoms resolved within 10 days. Acute calcific tendinitis of the longus colli muscle results from asceptic inflammation of the longus colli muscle in the cervical prevertebral space, due to calcium hydroxyapatite crystal deposition.1 It is benign and self-limiting and presents classically with acute severe neck pain, neck stiffness and odynophagia.2,3 Inflammatory markers may be raised. Diagnosis may be made on imaging, with CT being the gold standard, showing pre-vertebral soft tissue swelling and amorphous calcification in the longus colli muscle anterior to C1–C2.2 Treatment is usually with non-steroidal anti-inflammatory medications, with symptoms generally resolving within 1–2 weeks.3

Figure 1: 

c 

Panel A, lateral radiograph showing calcification anterior to C2 (arrow) with prevertebral soft tissue swelling. 
Panels B and C, CT in bone windows showing amorphous calcification within the left longus colli muscle anterior to the C2 vertebral body (arrow). 
Panel D, CT in soft tissue window showing simple fluid in the prevertebral space anterior to the C2 vertebral body (arrow). 

Author Information

Michael Plunkett, Registrar in General Medicine, Counties Manukau District Health Board, Auckland; Hugh De Lautour, General Physician and Rheumatologist, Department of Medicine, Waitemata District Health Board, Auckland; Adam Worthington, Radiologist, Department of Radiology, Waitemata District Health Board, Auckland.

Correspondence

Michael Plunkett, Department of General Medicine, Counties Manukau District Health Board, Private Bag 93311, Otahuhu, Auckland 1640.

Correspondence Email

michaelplunkett2@gmail.com

Competing Interests

Nil.

References

  1. Ring D, Vaccaro AR, Scuderi G, Pathria MN, Garfin SR. Acute calcific retropharyngeal tendinitis. Clinical presentation and pathological characterization. J Bone Jt Surg Am. 1994; 76(11):1636–42.
  2. 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):117–21. 
  3. Zibis AH, Giannis D, Malizos KN, et al. Acute calcific tendinitis of the longus colli muscle: Case report and review of the literature. Eur Spine J. 2013; 22(SUPPL.3):434–8.