Acute calcific tendinitis of longus colli: An uncommon cause of acute neck pain

N Gopinath Thandre; Shaji Padinjatel; Krishnakiran Karanth; Jagdish Jagalpathy

doi:10.4103/1115-1474.128087

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CASE REPORT

Year : 2014 | Volume : 21 | Issue : 1 | Page : 38-41

Acute calcific tendinitis of longus colli: An uncommon cause of acute neck pain

N Gopinath Thandre, Shaji Padinjatel, Krishnakiran Karanth, Jagdish Jagalpathy
Department of MRI, Dr. Shaji MRI and Research Centre, Calicut, Kerala, India

Date of Web Publication

3-Mar-2014

Correspondence Address:
N Gopinath Thandre
Dr. Shajis MRI and Research Centre, Puthiyara, Kozhikode - 673 001, Kerala
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1115-1474.128087

Abstract

Acute calcific tendinitis of the longus colli muscle is an inflammatory condition associated with calcifications in longus colli muscle fibers which can present as acute neck pain. We present a case of a patient presenting with acute neck pain. MRI showed retropharyngeal effusion and edema of the left side longus colli muscle. CT showed amorphous calcifications in prevertebral region at C2 level which is a characteristic finding. Effusion in left lateral atlantoaxial joint is an uncommon associated finding in this condition which was seen in this case. It is important to recognize imaging features to prevent unnecessary investigations and surgical intervention.

Keywords: Calcific tendinitis; CT; longus colli; magnetic resonance imaging

How to cite this article:
Thandre N G, Padinjatel S, Karanth K, Jagalpathy J. Acute calcific tendinitis of longus colli: An uncommon cause of acute neck pain. West Afr J Radiol 2014;21:38-41

How to cite this URL:
Thandre N G, Padinjatel S, Karanth K, Jagalpathy J. Acute calcific tendinitis of longus colli: An uncommon cause of acute neck pain. West Afr J Radiol [serial online] 2014 [cited 2023 Jun 4];21:38-41. Available from: https://www.wajradiology.org/text.asp?2014/21/1/38/128087

Introduction

Acute calcific tendinitis of the longus colli muscle is an inflammatory condition associated with calcium deposition in the longus colli muscle. ^[1] It can mimic other causes of neck pain caused by infection, neoplasm, and trauma. ^[2] CT shows characteristic calcifications in superior fibers of the longus colli muscle. ^[1] It is important to recognize imaging findings since this is a benign condition and resolves in few days. We report a case of acute longus colli calcific tendinitis presenting with acute neck pain.

Case Report

A 50-year-old male presented with acute neck pain and odynophagia since 7 days. There was associated sore throat. Mild elevation of white cell count was seen. There was no history of trauma. Initial plain radiography of neck revealed increased thickness of prevertebral soft tissue [Figure 1]. MRI showed a uniform retropharyngeal effusion from C1-C4 level [Figure 2]. There was increased signal on T2-weighted images on the left side longus colli muscle at C1-C2 level [Figure 3]. Effusion was seen in left atlanto axial joint [Figure 4]. C5 and C6 vertebrae showed signal abnormalities of endplates, hypointense on T1weighted and hyperintense on T2weighted images which represent degenerative endplate changes. CT scan of the neck showed focal calcifications anterior to C2 vertebra [Figure 5] and [Figure 6]. Based on imaging findings, the diagnosis of acute longus colli calcific tendinitis was evoked. The patient was treated with anti-inflammatory medicines and rest. After 1 week there was complete resolution of symptoms. A follow-up plain radiograph of lateral cervical spine showed decreased thickness of prevertebral soft tissue [Figure 7]. Normal thickness of posterior pharyngeal space at level of C3 vertebra ranges from 1.5 to 4.5 mm. ^[3]

Figure 1: 50 year old male with acute longus colli calcific tendinitis. Lateral radiograph of cervical spine shows increased prevertebral soft tissue thickness (arrow)

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Figure 2: A 50‑year‑old male with acute longus colli calcific tendinitis. Sagittal T2 of cervical spine showing retropharyngeal effusion (arrow) from C1 to C4 levels

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Figure 3: Axial MEDIC sequence at C1 level showing hyperintense signal in left side longus colli muscle

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Figure 4: Coronal short tau inversion recovery (STIR) of cervical spine showing effusion (arrow) in left lateral atlantoaxial joint

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Figure 5: A 50‑year‑old male with acute longus colli calcific tendinitis. Axial CT of neck at level of C1‑2 showing calcifications (arrow) anterior to C1‑2

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Figure 6: 50 year old male with acute longus colli calcific tendinitis. Axial CT of neck at level of C1‑2 showing calcifications (arrow) anterior to C1‑2

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Figure 7: Follow up plain lateral radiograph of cervical spine showing decreased thickness of prevertebral soft tissue

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Discussion

Acute calcific tendinitis of the longus colli muscle is an inflammatory condition. It is associated with calcium hydroxyapatite deposition in the longus colli muscle. The condition was described originally by Hartley ^[4] in 1964 and was demonstrated by Ring ^[2] and colleagues in 1994 to be secondary to calcium hydroxyapatite deposition in the longus colli muscle. Calcific tendinitis is a well-known condition of shoulder. ^[5] It has also been described at other sites like rectus femoris, ^[6] hip (gluteus maximus), ankle (peroneus longus), ^[5] hand, and wrist. ^[7],[8]

The aetiopathogenesis of calcific tendinitis is still controversial, but it seems to be the result of an active cell-mediated process. ^[9] Different theories have been proposed to explain the pathophysiology. Uthoff et al. proposed the theory of reactive calcification which involves an active cell-mediated process. ^[10] Benjamin et al. suggested that calcium deposits are formed by a process resembling endochondral ossification. ^[11] Rui et al. proposed theory of ectopic bone formation from metaplasia of stem cells normally present in tendon tissue into osteogenic cells. ^[12]

The longus colli muscle consists of superior (upper oblique), central (vertical), and inferior (lower oblique) fibers. ^[12] The superior fibers attach the anterior tubercle of the atlas to the anterior tubercles of the transverse processes of C3-C5 vertebrae; the inferior fibers connect the bodies of T1-T3 vertebrae to the anterior tubercles of the transverse processes of C5-C6 vertebrae; the central fibers attach the bodies of C2-C4 vertebrae to the remaining cervical and upper three thoracic vertebrae. It is the superior tendon fibers of the longus colli muscle that are affected in acute calcific tendinitis. ^[13]

Neck pain could be caused by various conditions like retropharyngeal abscess, infective spondylodiscitis, cervical spine trauma, degenerative disc disease, meningitis. CT and MRI are helpful in differentiating these conditions.

This condition affects adults within a reported age range of 21 to 81 years although most patients are between 30 and 60 year age. ^[14] Clinically patients may present with neck pain, dysphagia, odynophagia, low grade fever, elevated white cell count, and limited range of motion. The disease may occur in association with collagen vascular disease, renal failure, and osteoarthritis. ^[15]

Lateral radiograph of cervical spine may show calcifications anterior to C2. CT is more sensitive than plain radiograph to detect calcifications. ^[16] CT shows pathognomonic finding of calcifications in the longus colli muscle anterior to C2. C1-3 is the common site of calcification although cases have been described with calcifications anterior to C4-5 ^[17] and C5-6. ^[18] MRI is less accurate compared to CT in detection of calcifications. MRI shows retropharyngeal effusion and signal abnormality in the longus colli muscle. Effusion in left lateral atlantoaxial joint was seen in our case which is an uncommon finding. It has been described in a case in which a patient showed in addition to classical findings, effusion in both lateral atlantoaxial joints. ^[19] Retropharyngeal effusion must be differentiated from abscess. Smooth expansion of retropharyngeal space by fluid, absence of enhancing wall in the periphery, lack of suppurative nodes, and presence of calcifications favor the diagnosis of longus colli calcific tendinitis. ^[1]

Acute calcific tendinitis of longus colli is a benign condition and resolution of symptoms can be expected in 72 hours with anti-inflammatory medications. ^[15]

Conclusion

Acute longus colli calcific tendinitis is a benign inflammatory condition associated with characteristic calcification anterior to C2. Recognition of the pathognomonic imaging finding is important to avoid unnecessary investigations and surgical intervention. Effusion in lateral atlantoaxial joint is an uncommon feature of this condition and was seen in our case.

References

1.	Eastwood JD, Hudgins PA, Malone D. Retropharyngeal effusion in acute calcific prevertebral tendinitis: Diagnosis with CT and MR imaging. AJNR Am J Neuroradiol 1998;19:1789-92.
2.	Ring D, Vaccaro AR, Scuderi G, Pathria MN, Garfin SR. Acute calcific retropharyngeal tendinitis.Clinical presentation and pathological charactarization. J Bone Joint Surg Am 1994;76:1636-42.
3.	OON CL. Some sagittal measurements of the neck in normal adults. Br J Radiol 1964;37:674-7.
4.	Hartley J. Acute cervical pain associated with retropharyngeal calcium deposit: A case report. J Bone Joint Surg Am 1964;46:1753-4.
5.	Hall FM, Docken WP, Curtis HW. Calcific tendinitis of the longus colli: Diagnosis by CT. AJR Am J Roentgenol 1986;147:742-3.
6.	Kim YS, Lee HM, Kim JP. Acute calcific tendinitis of the rectus femoris associated with intraosseous involvement: A case report with serial CT and MRI findings. Eur J Orthop Surg Traumatol 2013 Nov; 23 Suppl 2:233-9.
7.	Harris AR, McNamara TR, Brault JS, Rizzo M. An Unusual Presentation of Acute Calcific Tendinitis in the Hand. Hand (NY) 2009;4:81-3.
8.	Yammine K. Acute calcific periarthritis in hands. Pseudogout Presentation in Four cases. Int Musculoskeletal Med 2011;33;167-9.
9.	Oliva F, Via AG, Maffulli N. Physiopathology of intratendinous calcific deposition. BMC Med 2012;10:95.
10.	Uhthoff HK, Loehr JW. Calcific tendinopathy of the rotator cuff: Pathogenesis, diagnosis and management. J Am Acad Orthop Surg 1997;5:183-91.
11.	Benjamin M, Rufai A, Ralphs JR. The mechanism of formation of bony spurs (enthesophytes) in the Achilles tendon. Arthritis Rheum 2000;43:576-83.
12.	Rui YF, Lui PP, Chan LS, Chan KM, Fu SC, Li G. Does erroneous differentiation of tendon-derived stem cells contribute to the pathogenesis of calcifying tendinopathy? Chin Med J (Engl) 2011;124:606-10.
13.	Offiah CE, Hall E. Acute calcific tendinitis of the longus colli muscle: Spectrum of CT appearances and anatomical correlation. Br J Radiol 2009;82:e117-21.
14.	Kaplan MJ, Eavey RD. Calcific tendinitis of the longuscolli muscle. Ann Otol Rhinol Laryngol 1984;93:215-9.
15.	Smith RV, Rinaldi J, Hood DR, Troost T. Hydroxyapatite deposition disease: An uncommon cause of acute odynophagia. Otolaryngol Head Neck Surg 1996;114:321-3.
16.	Artenian DJ, Lipman JK, Scidmore GK, Brant-Zawadzki M. Acute neck pain due to tendinitis of the longus colli: CT and MRI findings. Neuroradiology 1989;31:166 -9.
17.	Lee S, Joo KB, Lee KH, Uhm WS. Acute Retropharyngeal Calcific Tendinitis in an Unusual Location: A Case Report in a Patient with Rheumatoid Arthritis and Atlantoaxial Subluxation. Korean J Radiol 2011;12:504-9.
18.	Park SY, Jin W, Lee SH, Park JS, Yang DM, Ryu KN. Acute retropharyngeal calcific tendinitis: A case report with unusual location of calcification. Skeletal Radiol 2010;39:817-20.
19.	Ellika SK, Payne SC, Patel SC, Jain R. Acute calcific tendinitis of the longus colli: An imaging diagnosis. Dentomaxillofac Radiol 2008;37:121-4.