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[Clinical Picture] A pain in the neck: calcific tendinitis of the longus colli muscle

Tags: General

A 41-year-old man presented to our hospital with a 20-h history of progressively worsening sudden-onset, severe, left-sided neck pain. Additionally, he complained of a headache in the occipital region, odynophagia, and trismus. He reported no medical history of trauma or infection. A physical examination showed he had severely limited neck motion in all directions because of stiffness. Blood tests showed a leucocytosis (13·0 × 10 9 per L), an elevated serum C-reactive protein concentration (124 mg/L), and a faster erythrocyte sedimentation rate (24 mm/h). A cervical spine x-ray showed swelling in both the retropharyngeal and prevertebral spaces and ill-defined calcifications anterior to the C2 ( figure). A CT scan of the cervical spine showed calcifications in the longus colli muscle inferior to the anterior arch of the C1 and marked swelling and effusion in the retropharyngeal and prevertebral spaces ( figure). Acute calcific tendinitis of the longus colli muscle was diagnosed, and an oral non-steroidal anti-inflammatory drug, loxoprofen, was prescribed for 5 days at a dose of 180 mg per day. The symptoms began to resolve within a few hours, and the range of the patient's neck movements recovered significantly within 2 days. And within 1 week, the patient was completely symptom-free.
Figure thumbnail gr1

Figure Acute calcific tendinitis of the longus colli muscle

An x-ray of the cervical spine shows swelling in the retropharyngeal and prevertebral spaces (arrows) and suspected calcifications anterior to C2 (arrow heads) (A). A cervical CT shows calcification of the longus colli muscle at the level of C1 and C2 (arrow heads) and effusions in the retropharyngeal and prevertebral spaces (arrows) with sagittal (B) and axial (C) views. Three-dimensional reconstructed cervical CT scan shows calcification of the left upper oblique fibres of the longus colli muscle tendon (D).

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