Summary: An otherwise healthy 39-year-old man presented the emergency room
with a 3-day history of throat pain and stiff neck. Direct
visualization of the pharynx revealed prominent retropharyngeal
soft tissues with a normal mucosal surface. The patient's
temperature was 99.9˚, white count was 12,000/mL, and the
sedimentation rate was 9. Radiographs of the soft tissues of the
neck were performed, followed by contrast-enhanced computed
tomography (CT), and magnetic resonance imaging (MRI) of the neck
for further characterization.
Acute calcific tendonitis of the longus colli muscle
A lateral radiograph of the soft tissues of the neck reveals
smooth, mild thickening of the prevertebral soft tissues (5 mm),
with a 1.3 cm focus of amorphous calcification anterior to the C2
vertebrae (Figure 1). A contrast-enhanced CT exam (with sagittal
reconstructed images) showed a smooth, lenticular-shaped fluid
collection within the prevertebral soft tissues. In addition,
amorphous calcification was seen embedded within the superior
oblique tendon (proximal tendon of the longus colli muscle; Figure
2). An MRI examination also depicted a lenticular shaped
prevertebral fluid collection with amorphous calcification in the
proximal fibers of longus colli tendon, at its origin from the
anterior arch of the C1 vertebrae (Figure 3).
Acute retropharyngeal tendonitis (calcific tendonitis of the
longus colli), initially described by Hartley in 1964, is an acute
inflammation condition of the longus colli tendon, which is related
to calcium hydroxyapatite deposition in the superior oblique fibers
of the longus colli muscles.1-3 The longus colli muscle
extends from the anterior arch C1 to the T3 vertebrae.4
Patients most often present during the third through sixth decades
of life5 with acute neck pain, stiffness, odynophagia,
low-grade fever and mild leukocytosis.2-8 The clinical
presentation can be difficult to differentiate from a
retrophayngeal abscess. Radiology can play a key role in the
diagnosis: specifically, by identifying characteristic, amorphous
calcification in the proximal fibers of the longus colli (just
inferior to the anterior arch of theatlas); and, by identifying a
prevertebral fluid collection/effusion, which is considered nearly
pathognomonic of this entity. The prevertebral fluid collections in
this entity tend to be smooth, linear/lenticular and do not contain
an enhancing wall (as one may expect with an
Acute retropharyngeal tendonitis is a cause of acute neck pain
that can mimic infection (retropharyngeal abscess, pharyngitis or
peritonsilar abscess). Recognition of this entity is critical in
order to avoid misdiagnosis and inappropriate treatment with
antibiotics and possible"abscess" drainage. In the proper clinical
setting, the presence of amorphous calcification anterior to C1/
C2, along with prevertebraledema/fluid, is nearly pathognominic of
Given the clinical symptoms, physical examination and specific
imaging findings, the diagnosis of acute calcific tendonitis of the
longus colli was established. At this point, empiric antibiotic
therapy was discontinued, and the patient was treated with
nonsteroidalanti-inflammatory medication. The patient responded
well to conservative treatment and subsequently made a full
Hartley J. Acute cervical pain
associated with retropharyngeal calcium deposit: A case report.
J Bone Joint Surg Am. 1964;46:1753-1754.
- Ring D, Vaccaro AR, Scuderi G, et al. Acute calcific
retropharyngeal tendonitis: Clinical presentation and pathological
characterization. J Bone Joint Surg Am.
- Eastwood JD, Hudgins PA, Malone D. Retropharyngeal effusion in
acute calcific prevertebral tendonitis: Diagnosis with CT and MR
imaging. AJNR Am J Neuroradiol. 1998;19:1789-1792.
- Benanti JC, Grambling O, Bulat PI et al. Retropharyngeal
calcific tendinitis: Report of five cases and review of the
literature. J Emerg Med. 1986;4(1):15-24.
- Kaplan MJ, Eavey RD. Calcific tendinitis of the longus colli
muscle. Ann Otol Rhinol Laryngol. 1984;93(3 pt
- Newmark H 3d, Forrester DM, Brown JC, et al. Calcific
tendinitis of the neck. Radiology. 1978; 128:355-358.
- Haun CL. Retropharyngeal tendinitis. Am J Roentgenol.
- Artinian DJ, Lippman JK, Scidmore GK, Brandt-Zawadzki M. Acute
neck pain due to tendonitis of the longus colli: CT and MRI
findings. Neuroradiology. 1989;31(2):166-169.