Clin Exp Emerg Med 2024;11(1):115-116

https://doi.org/10.15441/ceem.23.079

Images in Emergency Medicine

Calcific tendinitis of the longus colli pISSN: 3022-1811

muscle eISSN: 2383-4625

Daniel Vaccaro Sumi , Rafael Maffei Loureiro

Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil

An otherwise healthy woman in her 50s presented to the emergency department with a 7-day Received: June 21, 2023
Revised: July 18, 2023
history of odynophagia and posterior neck pain, radiating to the occipital region and worsening
Accepted: July 18, 2023
with movement. No fever or cervical stiffness was noted. Her C-reactive protein level was high
(112 mg/L), and her white blood count was 12,800/µL. Correspondence to: Daniel Vaccaro Sumi
At first, a carotid or vertebral artery dissection was considered as the probable diagnosis, but Department of Radiology and
it was excluded by computed tomography (CT) angiography. Neck CT and magnetic resonance imag- Diagnostic Imaging, Hospital Israelita
Albert Einstein, Av. Albert Einstein,
ing (MRI) exams were performed later (Figs. 1, 2) and confirmed the diagnosis of acute calcific ten-
627/701, São Paulo 05652-900, Brazil
dinitis of the longus colli muscle (ACTLCM). In retrospect, the imaging findings revealed that the Email: daniel.sumi@einstein.br
characteristic features of ACTLCM had been overlooked on the initial CT angiography exam.
ACTLCM is a rare, self-limited condition characterized by calcium deposition in the superior
oblique tendon fibers of the longus colli muscle and a secondary inflammatory reaction. Typical
symptoms are acute-onset odynophagia, neck pain, and stiffness; other symptoms include limit-
ed cervical range of motion, occipital headache, trismus, and low-grade fever. These symptoms
can be misdiagnosed as meningitis or another life-threatening condition such as retropharyn-
geal abscess or infectious spondylitis. Dysphagia, odynophagia, and the absence of photophobia
are clinical aspects more often associated with retropharyngeal processes, and they can help
differentiate ACTLCM from meningitis [1]. Specific imaging findings include amorphous calcifi-
cations anterior to the C1–C2 vertebrae with adjacent soft-tissue edema and fluid collection in
retropharyngeal space, and they can help to exclude spondylitis and retropharyngeal abscess. CT
and MRI are preferable to radiographs. Treatment includes immobilization, analgesics, and non-
steroidal anti-inflammatory drugs, as well as corticosteroids in severe cases. Symptoms usually
resolve within 2 weeks. This patient received analgesics, corticosteroids, and a cervical collar, and
the symptoms resolved in 5 days. Early and accurate diagnosis is the key to proper patient man-
agement [2–4].

What is already known

Acute calcific tendinitis of the longus colli muscle is a rare, benign, and How to cite this article:
self-limited condition characterized by acute-onset neck pain, neck stiffness,
Sumi DV, Loureiro RM. Calcific tendinitis of
and odynophagia. the longus colli muscle.
Clin Exp Emerg Med 2024;11(1):115-116.
What is new in the current study https://doi.org/10.15441/ceem.23.079
This case highlights how acute calcific tendinitis of the longus colli muscle can
mimic the clinical presentation of neck arterial dissection, potentially resulting
in a failure to recognize acute calcific tendinitis in initial cross-sectional imag- This is an Open Access article distributed
ing examinations focused on blood vessels. under the terms of the Creative Commons
Attribution Non-Commercial License (http://
creativecommons.org/licenses/by-nc/4.0/).

© 2024 The Korean Society of Emergency Medicine 115


A B
Fig. 1. (A, B) Sagittal contrast-enhanced computed tomography images
show an amorphous calcification at the C1–C2 level (arrowheads), with
adjacent soft-tissue thickening (white arrows). There is nonenhancing
fluid in the retropharyngeal space consistent with effusion (yellow ar-
row).
A B
Fig. 2. T2-weighted magnetic resonance images show fluid collection
in the retropharyngeal space (yellow arrows). Soft-tissue thickening and
edema at the level of the superior fibers of the right longus colli muscle
(white arrows) and an amorphous calcification (arrowheads) are also
visible. (A) Sagittal view. (B) Axial view.
116
Calcific tendinitis of the longus colli muscle
Ethics statement
All personal data were removed, and images were entirely ano-
nymized.
ARTICLE INFORMATION
Author contributions
Conceptualization: RML; Investigation: all authors; Project ad-
ministration: DVS; Supervision: DVS; Visualization: DVS; Writing–
original draft: all authors; Writing–review & editing: all authors.
All authors read and approved the final manuscript.
Conflicts of interest
The authors have no conflicts of interest to declare.
Funding
The authors received no financial support for this study.
Data availability
Data sharing is not applicable as no new data were created or
analyzed in this study.
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Frequency of acute longus colli tendinitis on CT examinations.
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