What is the diagnosis?

Calcific tendinitis of the longus colli muscle, also known as retropharyngeal or acute calcific prevertebral tendinitis. This is a self-limiting and benign inflammatory response to the deposition of calcium hydroxyapatite in the tendons of the longus colli muscle [1].

Image 2. Author’s image with finding annotation

What is the typical clinical presentation?

This is most common in patients 30-60 years of age. Symptoms often develop acutely and include neck pain, dysphagia, odynophagia, trismus, and decreased range of motion of the neck(?). Patients may have fevers, leukocytosis, and elevated inflammatory markers such as ESR and CRP [2].

What differential diagnoses should be considered?

Calcific tendinitis of the longus colli can present similarly to retropharygeal abscess or other deep-space neck infections. Also consider neck masses, disc herniation, diffuse idiopathic skeletal hyperostosis, and occult trauma [2].

•  Pearl: A contrast-enhanced CT of the neck is the gold standard for diagnosis and can help differentiate from other causes of neck pain such as retropharyngeal abscess. This will typically demonstrate calcifications to the superior aspect of the longus colli tendon around the C1-C2 disc space, although calcifications can occur at any level [3].

What is the ED management and disposition?

Conservative management with oral NSAIDs. Symptoms will typically resolve within 1-2 weeks [1].

When should you get a specialist involved?

Consider consulting ENT if the patient has concern for airway compromise or there is difficulty differentiating from retropharyngeal abscess on CT [2].