Prevertebral Calcific Tendinitis

Abstract

Objective: 1) Recognize that prevertebral calcific tendinitis of the longus colli is a rare inflammatory noninfectious cause of retropharyngeal fluid. 2) Understand that appropriate treatment of this condition is with anti-inflammatory medications rather than antibiotics and/or surgical drainage.

Method: We report a rare case of retropharyngeal effusion caused by prevertebral calcific tendinitis of the longus colli muscle. The patient was evaluated and treated in the emergency department of an urban university hospital and was seen one week later in the otolaryngology clinic.

Results: Prevertebral calcific tendinitis of the longus colli is a rare entity that may cause an effusion that can be misdiagnosed as a retropharyngeal abscess. Our patient presented with a 1 day history of worsening neck pain and stiffness, and dysphagia. Absence of fever and a normal white cell count were noted. CT scan revealed a nonrim-enhancing, nonbulging retropharyngeal fluid collection and calcification of the longus colli tendons near the C2 vertebrae. One dose of intravenous dexamethasone was administered, and the patient’s neck stiffness markedly improved. At 1-week follow-up, his symptoms had completely resolved on a steroid taper.

Conclusion: Prevertebral calcific tendinitis of the longus colli may cause a retropharyngeal effusion mimicking abscess. Prompt diagnosis can be made by recognizing the characteristic CT findings in the context of absent clinical evidence for infection. Anti-inflammatory medications are the treatment of choice.