Calcific Tendinitis of the Longus Colli Muscle

Calcific tendinitis of the longus colli muscle, also known as acute retropharyngeal calcific tendinitis and calcific prevertebral tendinitis, is an inflammatory/granulomatous response to deposition of calcium hydroxyapatite crystals in the tendons of the longus colli muscle.

Calcifications may be seen on radiographs, but the preferred imaging modality is contrast-enhanced CT. On CT, amorphous calcifications are seen in the superior fibers of the longus colli muscle tendons (at the C1–C2 level). Small retropharyngeal effusions and edema of the adjacent prevertebral soft tissues may also be seen. Enhancement around the effusion should shift the diagnosis towards an abscess. Adenopathy and bone destruction, likewise, should suggest alternative diagnoses.

MRI will show the edema, but is not as great with the calcifications. At least one case of localized marrow signal inflammatory has been reported.

Patients may present with debilitating symptoms that are unrelated to the degree of calcification seen on CT. Conservative management with NSAIDs is generally all that is needed, and symptoms resolve within a few weeks.

The patient in the case shown here presented with throat and neck pain for 2 days. She was unable to straighten her neck from the neutral position and had pain on turning her head and swallowing liquids or solids. She reported no fever, chills, or weight loss.

The images show (A) A small calcification anterior to the C4 vertebral body on the radiograph (arrow). (B) The amorphous calcification is better evaluated on the CT (arrow). Sagittal STIR (C) and coronal T2-weighted (D) images show edema anterior to the longus colli muscle.

References

• Offiah CE and Hall E. Acute calcific tendinitis of the longus colli muscle: spectrum of CT appearances and anatomical correlation. Br J Radiol. 2009 Jun;82(978):e117-21.
• Mihmanli I, Karaarslan E, Kanberoglu K. Inflammation of vertebral bone associated with acute calcific tendonitis of the longus colli muscle. Neuroradiology 2001;43:1098–101