Disclosures: Sheryl R. Levin, MD: No financial relationships or conflicts of interest

Case Diagnosis: Patient presenting with severe neck pain, odynophagia and retropharyngeal edema due to longus colli tendonitis.

Case Description or Program Description: A 40-year-old woman with a history of asthma presents with six days of increasingly severe, atraumatic anterior and posterior neck pain. No fever, chills or throat pain, but significant odynophagia. She is afebrile, physical examination notable only for painful, severely restricted cervical rotation. No neck mass, thyromegaly, lymphadenopathy or pharyngeal erythema; neurological examination unremarkable. White count is normal, no inflammatory markers were drawn.

Setting: Acute care hospital.

Assessment/Results: MRI cervical spine notable for retropharyngeal edema C1 through C3 and mineralization just inferior to the C1 anterior arch. CT/CTA notable for retropharyngeal edema from skull base through C3-C4, with bony calcification just below the tip of dens. Flexible laryngoscopy by ENT unrevealing. She received IV Toradol and transitioned to oral NSAIDs with good pain relief. Two days later, range of motion was functional, pain controlled and odynophagia resolved.

Discussion (relevance): Calcific tendonitis of the longus colli, an anterior prevertebral muscle, is unusual and an under-recognized cause of atraumatic neck pain. Patients present severe neck pain, limited cervical motion and often odynophagia. Neurological examination is normal. Low grade fever and elevation of inflammatory markers may be present. Advanced imaging is notable for calcium deposition anterior to C1- C2, with retropharyngeal edema due to the muscle location. This generates concern for occult infection or unrecognized trauma, and further workup. The underlying cause of this condition is calcium hydroxyapatite deposition in the longus colli muscle, typically at C1-2. This self-limited process improves within days of NSAID administration.

Conclusions: The differential diagnosis of severe, atraumatic neck pain with odynophagia includes longus colli tendinitis. Typical radiographic findings are notable for calcium deposits anterior to C1 – C2, with pre vertebral swelling. Recognition of the clinical presentation and the characteristic radiographic findings can prevent unnecessary invasive workup.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/longus-colli-tendonitis-an-unusual-presentation-of-atraumatic-neck-pain/