Transcript Slide 1

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.
Discussion
• 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
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