626 - Calcific Tendonitis of the Longus Colli Muscle, broadening the differential diagnosis for acute neck pain

This report describes a 53 year old woman who presented for evaluation of right-sided lateral and posterior neck pain. Symptoms began approximately 6 days prior with no inciting event. The pain was non-radiating and she denied any bowel, bladder, or dexterity issues. She reports some pain with swallowing and there was no positional preference with her neck pain.  

She had not previously received any physical therapy, joint injections, or surgeries. There was tenderness noted along the right and left levator scapulae, upper trapezius, right cervical paraspinal, and right scalene muscles. Cervical flexion, extension, lateral bending, and rotation was limited due to pain.

Radiographs in office with findings of widening of prevertebral space with concern for possible underlying soft tissue abscess. CT soft tissue of the neck with contrast revealed an amorphous calcification of the right longus colli muscle measuring 0.8 x 0.5 x 0.8 cm with reactive retropharyngeal edema.

Discussions:

Acute CTLC is characterized by the deposition of calcium hydroxyapatite with subsequent inflammation of the longus colli muscle. The resulting inflammation from CTLC can resemble that of a retropharyngeal abscess on x-ray of the cervical spine, supporting the diagnostic utility of cervical radiographs for cervical pain. Follow-up with advanced imaging to discern between the two diagnoses is essential. 

Conclusions:

Calcific tendonitis is a common source of joint pain. However it can present itself as an underdiagnosed source of acute cervical spine pain. CTLC can be clearly recognized through advanced imaging however may mimic more common sources of neck pain such as discogenic or myofascial pain on physical examination.