Calcific tendinitis of the longus colli muscle

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.

Epidemiology

This condition typically occurs in adults in middle age (20-50 years of age) with a slight predilection for females ³. 

Clinical presentation

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.

Radiographic features

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 fibres of the longus colli muscle tendons (at the C1-C2 level) ^1-3. Occasionally the inferior fibres may be affected, as low down as T3. The longus colli muscles may also appear hypo-attenuating due to oedema.

Small retropharyngeal effusions and oedema 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

MRI will easily demonstrate the oedema, however, a high level of suspicion is needed as the calcifications are much harder to visualise.

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. 

Differential diagnosis

• retropharyngeal abscess
  • prominent surrounding enhancement
  • diffusion restricting fluid within the collection
  • cervical lymphadenopathy
• trauma
  • prevertebral bone fragments from acute fractures may be mistaken for calcification in the longus colli tendons
• tumour
  • 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.