Retropharyngeal tendinitis: radiographic and magnetic resonance imaging findings

A 67-year-old man with odynophagia and neck pain

Acute calcific longus colli tendinitis is a benign and self-limiting inflammatory disease that rarely requires aggressive intervention. However, clinicians may be unfamiliar with this condition, and it can easily be misdiagnosed for a deep neck abscess or tumor resulting in unnecessary and invasive procedures. This article describes a patient who presented to the ED with progressive odynophagia and neck pain.

Longus colli tendinitis. A review of literature and case series

Purpose: To increase the awareness of longus colli tendinitis (LCT) among spine specialists and to present a practical overview of diagnostic and treatment options, so that unnecessary interventions are avoided. Five sample cases from a German spine center will also be presented.

Methods: Literature review and case series. A PubMed search was performed in May 2015, and the articles found were reviewed for clinical presentation, investigations, and treatment. The frequency of publication of LCT cases and the specialty of journals were also noted. Recent cases treated in our institution were also reviewed. The clinical findings, investigations, and therapeutic interventions were summarized.

Results: The PubMed search from May 2015 found 104 articles, published over 51 years, on the topic of LCT. Only four were published in spine journals. A review of this literature yielded a total of 242 cases. The classic clinical triad included neck pain, limitation of movements, and swallowing complaints. C-reactive Protein (CRP) values were available in 21 cases (mean 23.66 mg/dL). A contrast-enhanced computed tomography (CT) scan was the best diagnostic modality. LCT is usually a self-limiting condition, but non-steroidal anti-inflammatory drugs (NSAIDs) may help alleviate discomfort. Five cases of LCT were diagnosed and treated in our center over the past three years.

Conclusions: LCT, which is uncommon and has non-specific symptoms, is often referred to spine centers. Spine specialists should be aware of its clinical presentation and radiographic findings in order to avoid unnecessary interventions. The condition is self-limiting and can be treated conservatively.

Acute prevertebral calcific tendinitis: a source of non-surgical acute cervical pain

BACKGROUND

Prevertebral calcific tendinitis results from calcium hydroxyapatite crystal deposits in the longus colli muscles, which induce symptoms similar to some surgically-treated conditions, such as retropharyngeal abscesses. Imaging techniques are critical for accurate diagnosis.

PURPOSE

To describe the computed tomography (CT) findings associated with prevertebral calcific tendinitis.

MATERIAL AND METHODS

Retrospective analysis performed in an 18-month period, searching for patients with neck CT and reports with diagnosis of "calcific longus collis tendinitis" or "prevertebral calcific tendinitis". CT images and clinical data available in the medical records were analyzed.

RESULTS

One hundred and thirty-four examinations were performed in the period studied. Nine patients who fulfilled inclusion criteria were identified and their CT imaging characteristics are presented. Six presented with calcific deposits in the right longus colli muscle. CT matched the clinical pain lateralization in all cases. Eight patients had no significant enhancement post injection of contrast media.

CONCLUSION

Prevertebral calcific tendinitis is a cause of acute cervical pain that clinically mimics a retropharyngeal abscess, however on neck CT has a characteristic appearance. Correct identification of this pathologic condition will help avoiding unnecessary invasive procedures.

Prevertebral tendinitis: how to avoid unnecessary surgical interventions

OBJECTIVES/HYPOTHESIS

Prevertebral tendinitis is an inflammatory process that affects the cervicothoracic prevertebral muscles. Because of its clinical presentation and imaging features in computed tomography scans, prevertebral tendinitis can easily be mistaken for deep cervical abscess formation. Totally different therapy regimens require clinical and diagnostic pathways for sufficient differentiation between those two pathologic entities.

STUDY DESIGN

Case series with comparison.

METHODS

In 10 patients with prevertebral tendinitis, we evaluated the symptoms, laboratory reports, and radiological imaging findings. We compared these data to 65 patients with a deep cervical abscess formation. The basic radiologic imaging procedure was contrast-enhanced computed tomography. For detection of prevertebral tendinitis, we performed magnetic resonance imaging with diffusion-weighted images and calculated the apparent diffusion coefficient map.

RESULTS

Patients with prevertebral tendinitis complained of severe neck pain, globus sensation, and neck stiffness. Diffusion-weighted images showed a typical benign prevertebral effusion. Computed tomography scans showed amorphous calcifications in the tendon of the prevertebral muscles. The C-reactive protein values were slightly increased in patients with prevertebral tendinitis, and white blood cell count remained normal. In comparison to patients with deep cervical abscess formation, the C-reactive protein and white blood cell count was significantly lower (P < .05) in the prevertebral tendinitis cases.

CONCLUSIONS

Prevertebral tendinitis should be considered when patients suffer from neck pain, neck stiffness, and globus sensations despite low signs of inflammation in the laboratory report. To confirm the diagnosis, the best imaging feature is magnetic resonance imaging with diffusion-weighted images and apparent diffusion coefficient map.

A Case of Retropharyngeal Abscess with Spondylitis Causing Tetraplegia

We report a case of retropharyngeal abscess with spondylitis causing tetraplegia. At a previous hospital, administration of antibiotics improved the inflammation findings. However, magnetic resonace imaging showed a remaining retropharyngeal abscess. This patient showed a disturbance of consciousness under this therapy. Therefore, he was admitted to our hospital and underwent a drainage operation. At 1 day after this operation, he recovered from the disturbance of consciousness.

Benign nuchal rigidity: the emergency department evaluation of acute prevertebral calcific tendonitis

Acute prevertebral calcific tendonitis (APCT) is a rare condition, the exact incidence of which is unknown. It is of particular interest to the emergency physician owing to the other potentially devastating conditions in the differential diagnosis of neck stiffness and/or odynophagia (including retropharyngeal abscess, infectious spondylitis, and meningitis.) In contrast, APCT has a benign clinical course and can be easily managed in the emergency department. We will present a case of APCT, followed by a brief discussion of the disease and current literature.

Pathways in the diagnosis of prevertebral tendinitis

INTRODUCTION

The prevertebral tendinitis is an inflammatory process, which affects the cervicothoracic prevertebral muscles. This extremely rare entity was first described by Hartley and Fahlgren in 1964 and until now there are just some case reports dealing with this process. Unfortunately it is quite easy to misdiagnose or mistake the prevertebral tendinitis as an abscess, because of the imaging features. The aim of this case series is to offer guidelines in the diagnosis of this rare disease to prevent unnecessary surgery.

MATERIAL AND METHODS

Six patients with already by imaging or retrospectively after surgery by pathologic report diagnosed prevertebral tendinitis were included in this study. None of these patients suffered from a chronically inflammatory disease. Three patients just received contrast enhanced computed tomography (CT) and another group of three patients received magnetic resonance imaging (MRI). In two out of three MRI examinations, we additionally performed diffusion weighted images and calculated the apparent diffusion coefficient (ADC) map. The laboratory reports obtained on the day of the computed tomography (CT) or magnetic resonance imaging (MRI) examinations were reviewed for C-reactive protein (CRP) and white blood cell count (WBCC).

RESULTS

All patients revealed a prevertebral cervical effusion. Five out of six patients showed amorphous calcifications in the tendon of the prevertebral muscles. In one case calcifications could not be identified at all because of very strong beam hardening artefacts caused by dental prothesis. The CRP values were increased in all patients (mean value 44.9 mg/l; SD ± 28.3). However, WBCC remained normal (mean value 8.4G/l; SD ± 2.7). Only for the two patients who received DWI it was possible to assess the quality of the prevertebral fluid accumulation and to detect the benign prevertebral effusion, which is typical for the retropharyngeal tendinitis.

CONCLUSION

According to the experience with our patients the best imaging feature is MRI with DWI and ADC map to reveal the benign prevertebral effusion and confirm the diagnosis of prevertebral tendinitis. In some cases MRI might not be available. Here we recommend CT scans to detect typical prevertebral calcifications. Especially a slight elevation of CRP and normal WBCC make the prevertebral tendinitis more likely.