Case 21

Discussion:

Retropharyngeal calcific tendonitis, also known as calcific prevertebral tendonitis, is secondary to calcium hydroxyapatite deposition in the longus colli muscle.  The proposed pathophysiology is that rupture of these calcific hydroxyapatite crystals provokes an inflammatory response in the surrounding longus colli muscle that leads to formation of reactive fluid in the retropharyngeal space surrounding the muscle. This may occur in association with underlying collagen vascular disorders, kidney failure or osteoarthritis.

Patients most often present during the third through sixth decades of life.  Retropharyngeal calcific tendonitis can be misdiagnosed as retropharyngeal abscess, traumatic injury, or infectious spondylitis. Symptoms include neck pain, dysphagia, odynophagia, and low-grade fever.

The diagnosis is made radiographically by calcification anterior to C1–C2 and prevertebral soft-tissue swelling. Prevertebral fluid collection/effusion has been described and is considered nearly pathognomonic of this entity. The prevertebral collections tend to be smooth, linear/lenticular and do not contain an enhancing wall (which helps distinguish it from an abscess).

References:

• Ring D, Vaccaro AR, Scuderi G, et al. Acute calcific retropharyngeal tendonitis: Clinical presentation and pathological characterization. J Bone Joint Surg Am. 1994;76(11):1636-1642.
• Benanti JC, Grambling O, Bulat PI et al. Retropharyngeal calcific tendinitis: Report of five cases and review of the literature. J Emerg Med. 1986;4(1):15-24.
• Kaplan MJ, Eavey RD. Calcific tendinitis of the longus colli muscle. Ann Otol Rhinol Laryngol. 1984;93(3 pt 1):215-219.
• Eastwood JD, Hudgins PA, Malone D. Retropharyngeal effusion in acute calcific prevertebral tendonitis: Diagnosis with CT and MR imaging. AJNR Am J Neuroradiol. 1998;19:1789-1792.