Case of the Month - October 2013

• 50 year old male with 2 week history of dysphagia and odynophagia. No trauma.

• Investigations reveal: – Temperature 37.5– WBC normal– C-spine X-rays reveal

prevertebral soft tissue swelling.

Case submitted by Yoan Kagoma, PGY2

Contrast Enhanced CT of the Neck

• What are the imaging findings?• What is the differential diagnosis? Diagnosis?

Sagittal Soft Tissue and Bone Windows

Axial Soft Tissue Window

Coronal Soft Tissue Window

Axial Bone Window

Findings

• Smooth soft tissue edema and swelling within the prevertebral soft tissues from C1-C4

• No evidence of peripheral enhancement.• Amorphous soft tissue calcifications

surrounding the atlanto-axial joint.

Differential Diagnosis

• Retropharyngeal abscess?• Retropharyngeal effusion?• Perivertebral space infection?• Other?

Diagnosis

• Findings are most in keeping with calcific tendonitis of the longus colli muscle.

• Infection or retropharyngeal abcess are less likely given that the patient is not febrile, has a normal white count, and the collection does not exhibit peripheral enhancement.

Discussion

• A rare diagnosis; first described by Hartley in 1964.

• Clinical presentation: dysphagia, odynophagia, subacute neck pain, and low grade pyrexia. There may be preceding URTI or minor neck trauma.

• Demographics: Most common amongst 30-60 year olds. No male/female predominance.

• Pathophysiology: granulomatous and/or inflammatory reaction due to deposition of calcium hydroxyapatite crystals within the fibers of the longus colli that insert into C1/C2.

• Treatment: anti-inflammatory and analgesic medications. Incision and drainage is NOT required.

Discussion

Discussion

The 3 imaging findings most suggestive of the diagnosis:• Amorphous calcifications in

the prevertebral muscles, particularly C1-C2

• Inflammation with swelling of prevertebral muscles

• Smoothly expanding retropharyngeal space edema

Image from Offiah C & Hall E. British Journal of Radiology. 2009 (82): e117-3121.

References• Acute calcific tendinitis of the longus colli muscle: spectrum

of CT appearances and anatomical correlation. Offiah C & Hall E. British Journal of Radiology. 2009 (82): e117-3121.

• Retropharyngeal Effusion in Acute Calcific Prevertebral Tendinitis: Diagnosis with CT and MR Imaging. Eastwood J et al. American Journal of Neuroradiology. October 1998 (19): 1789-1792.

• Acute cervical pain associated with retropharyngeal calcium deposit: a case report. Harley J. Journal of Bone and Joint Surgery. 1964 (46-A):1753–1754.

• StatDx – Acute Calcific tendonitis of the longus colli