Korean J Radiol.  2011 Aug;12(4):504-509. 10.3348/kjr.2011.12.4.504.

Acute Retropharyngeal Calcific Tendinitis in an Unusual Location: a Case Report in a Patient with Rheumatoid Arthritis and Atlantoaxial Subluxation

Affiliations
  • 1Department of Radiology, Hanyang University Hospital, Seoul 133-792, Korea. kbjoo@hanyang.ac.kr
  • 2Department of Physical Medicine and Rehabilitation, Hanyang University Hospital, Seoul 133-792, Korea.
  • 3Department of Rheumatology, Hanyang University Hospital, Seoul 133-792, Korea.

Abstract

Retropharyngeal calcific tendinitis is defined as inflammation of the longus colli muscle and is caused by the deposition of calcium hydroxyapatite crystals, which usually involves the superior oblique fibers of the longus colli muscle from C1-3. Diagnosis is usually made by detecting amorphous calcification and prevertebral soft tissue swelling on radiograph, CT or MRI. In this report, we introduce a case of this disease which was misdiagnosed as a retropharyngeal tuberculous abscess, or a muscle strain of the ongus colli muscle. No calcifications were visible along the vertical fibers of the longus colli muscle. The lesion was located anterior to the C4-5 disc, in a rheumatoid arthritis patient with atlantoaxial subluxation. Calcific tendinitis of the longus colli muscle at this location in a rheumatoid arthritis patient has not been reported in the English literature.

Keyword

Calcific tendinitis; Longus colli muscle; Magnetic resonance imaging (MRI); Computed tomography (CT); Rheumatoid arthritis

MeSH Terms

Adult
Arthritis, Rheumatoid/*complications
Atlanto-Axial Joint/*physiopathology
Calcinosis/*complications/*diagnosis
Diagnosis, Differential
Dislocations/*complications
Female
Humans
*Magnetic Resonance Imaging
Pharyngeal Diseases/*complications/*diagnosis
Tendinopathy/*complications/*diagnosis

Figure

  • Fig. 1 Acute retropharyngeal calcific tendinitis in 30-year-old woman. A. Initial plain radiograph showing atlantoaxial subluxation (arrows) and prevertebral soft tissue swelling (arrowheads). There is no evidence of calcification along anterior border of the cervical spine. B, C. Sagittal (B) and axial T2-weighted (C) images show prominent prevertebral soft tissue swelling and fluid collection at C1-6 (arrows). D. Axial T1-weighted image at level C1-2 shows bony erosion in odontoid process (arrowhead). E, F. Enhanced sagittal (E) and axial T1-weighted (F) images with fat suppression showing markedly decreased amounts of fluid collection and prevertebral soft tissue swelling (arrows) after just 10 hours. G, H. Sagittal reformatted (G) and axial (H) images showing amorphous calcification (arrows) at right para-midline location anterior to C4-5 disc. I, J. Follow-up sagittal T2-weighted (I) and T1-weighted (J) MR images revealing minimal amounts of fluid collection (arrows) and minor low signal intensity calcification (arrowheads) anterior to C4-5 disc. K. Follow-up sagittal reformatted CT image after two months demonstrating almost complete resolution of calcification anterior to C4-5 disc (arrowhead). L. Anatomical illustration of longus colli muscles and site of retropharyngeal calcific tendinitis.


Cited by  1 articles

A Case of Retropharyngeal Calcific Tendinitis in a Patient with Ankylosing Spondylitis
Hyae Jin Yoon, Changnam Son, Seunghun Lee, Kungbin Joo, Tae Hwan Kim
J Rheum Dis. 2013;20(6):385-388.    doi: 10.4078/jrd.2013.20.6.385.


Reference

1. Mihmanli I, Karaarslan E, Kanberoglu K. Inflammation of vertebral bone associated with acute calcific tendinitis of the longus colli muscle. Neuroradiology. 2001. 43:1098–1101.
2. Chung T, Rebello R, Gooden EA. Retropharyngeal calcific tendinitis: case report and review of literature. Emerg Radiol. 2005. 11:375–380.
3. 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–e121.
4. Southwell K, Hornibrook J, O'Neill-Kerr D. Acute longus colli calcific tendonitis causing neck pain and dysphagia. Otolaryngol Head Neck Surg. 2008. 138:405–406.
5. Smith RV, Rinaldi J, Hood DR, Troost T. Hydroxyapatite deposition disease: an uncommon cause of acute odynophagia. Otolaryngol Head Neck Surg. 1996. 114:321–323.
6. Hartley J. Acute Cervical Pain Associated with Retropharyngeal Calcium Deposit. A Case Report. J Bone Joint Surg Am. 1964. 46:1753–1754.
7. Kaplan MJ, Eavey RD. Calcific tendinitis of the longus colli muscle. Ann Otol Rhinol Laryngol. 1984. 93:215–219.
8. Diaw AM, De Maeseneer M, Shahabpour M, Machiels F, Osteaux M. Calcium hydroxyapatite deposition disease of the neck: finding in three patients. J Belge Radiol. 1998. 81:73–74.
9. De Maeseneer M, Vreugde S, Laureys S, Sartoris DJ, De Ridder F, Osteaux M. Calcific tendinitis of the longus colli muscle. Head Neck. 1997. 19:545–548.
10. Fahlgren H. Retropharyngeal tendinitis: three probable cases with an unusually low epicentre. Cephalalgia. 1988. 8:105–110.
11. Hall FM, Docken WP, Curtis HW. Calcific tendinitis of the longus coli: diagnosis by CT. AJR Am J Roentgenol. 1986. 147:742–743.
12. 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. 39:817–820.
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