Journal of Emergencies, Trauma, and Shock
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 Table of Contents    
LETTER TO EDITOR  
Year : 2015  |  Volume : 8  |  Issue : 2  |  Page : 119-120
Retropharyngeal calcific tendinitis: Report of two cases


1 Department of Emergency Medicine, Acibadem University, School of Medicine, Istanbul, Turkey
2 Fatih Sultan Mehmet Education And Research Hospital, Emergency Medicine Clinic, Istanbul, Turkey
3 Department of Otorhinolaryngology, Acibadem University, School of Medicine, Istanbul, Turkey
4 Department of Radiology, Pamukkale University, School of Medicine, Denizli, Turkey
5 Department of Emergency Medicine, Tekirdağ State Hospital, Tekirdağ, Turkey
6 Department of Radiology, Acibadem University, School of Medicine, Istanbul, Turkey

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Date of Web Publication21-Apr-2015
 

How to cite this article:
Yaylaci S, Öztürk TC, Aksoy E, Koçyigit A, Yılmaz A, Karaarslan E. Retropharyngeal calcific tendinitis: Report of two cases. J Emerg Trauma Shock 2015;8:119-20

How to cite this URL:
Yaylaci S, Öztürk TC, Aksoy E, Koçyigit A, Yılmaz A, Karaarslan E. Retropharyngeal calcific tendinitis: Report of two cases. J Emerg Trauma Shock [serial online] 2015 [cited 2019 Jul 23];8:119-20. Available from: http://www.onlinejets.org/text.asp?2015/8/2/119/145408


Sir,

Retropharyngeal calcific tendinitis (RCT), which is a little known but not an uncommon condition, should be considered as a differential diagnosis of neck pain. [1],[2] Here, we present two cases of RCT admitted to our emergency department (ED) with neck pain.

A 47-year-old woman was presented to the ED with sore throat and posterior neck pain for 2 days. Physical examination was normal. Her computed tomography (CT) images revealed 6-7 mm calcification anterior to C2 vertebra [Figure 1]. She has completely improved with 7 days of nonsteroidal anti-inflammatory drug (NSAID) therapy.
Figure 1: 3D CT image showed calcification of the longus colli muscle at the level of second cervical vertebra (arrow). 3D: Three dimensional; CT: Computed tomography

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A 42-year-old man was admitted to the ED with severe left and posterior neck pain, exacerbated by movement and food intake for 3 days. The patient exhibited a sore throat and fever (37.8°C). In blood examination, the only abnormal item was white blood cells (WBC) (15,800/μl). CT images revealed C3-C4 anterior longitudinal ligament calcification, and magnetic resonance imaging (MRI) demonstrated retropharyngeal prevertebral soft tissue edema and inflammation [Figure 2]. Because of the nontypical localization of the prevertebral calcification, retropharyngeal drainage was planned to rule out abscess. There was no material drained with the procedure. The cultures and biopsies did not show any infection. Hence, patient was discharged with medical treatment.
Figure 2: CT image demonstrated calcification in the region of prevertebral area of C3-C4 vertebra. CT: Computed tomography

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RCT is a benign, self-limited, and inflammatory condition of the longus colli tendon thought to be a form of calcium hydroxyapatite deposition disease. It is characterized by an acute onset of severe neck pain, odynophagia, and a painful restriction of neck movement. This disease mostly affects adults between 30- and 60-years old as our cases. The calcifications are usually present in the superior oblique portion of the longus colli muscle at the C1-C2 levels although a C5-C6 level has also been described. The most common treatment methods entailed the use of NSAID, steroids, or opiate analgesics. [3]

The presentation of this disease may be similar to more serious conditions such as retropharyngeal abscess (RPA), meningitis, cervical myopathy, and traumatic injury. It is important to note that the relatively benign condition of RCT is often misdiagnosed with RPA in 75% of patients. Patients with RPA usually present with neck pain, sore throat, dysphagia, or odynophagia that is also common in RCT. [4] RCT is a benign self-limiting disease that rarely requires admission, whereas RPA is associated with a high morbidity that may require antibiotics and surgical drainage for the treatment. [5] The diagnosis was also delayed in our second case, which also underwent surgical drainage to exclude RPA.

 
   References Top

1.
Kanzaria H, Stein JC. A severe sore throat in a middle-aged man: Calcific tendonitis of the longus colli tendon. J Emerg Med 2011;41:151-3.  Back to cited text no. 1
    
2.
Haran JP, Pezzella L. A case of neck pain: The presentation of Chairi 1 malformations in children. J Emerg Trauma Shock 2014;7:32-4.  Back to cited text no. 2
    
3.
Kusunoki T, Muramoto D, Murata K. A case of calcific retropharyngeal tendinitis suspected to be a retropharyngeal abscess upon the first medical examination. Auris Nasus Larynx 2006;33:329-31.  Back to cited text no. 3
    
4.
Park R, Halpert DE, Baer A, Kunar D, Holt PA. Retropharyngeal calcific tendinitis: Case report and review of the literature. Semin Arthritis Rheum 2010;39:504-9.  Back to cited text no. 4
    
5.
Gabra N, Belair M, Ayad T. Retropharyngeal calcific tendinitis mimicking a retropharyngeal phlegmon. Case Rep Otolaryngol 2013;2013:912628.  Back to cited text no. 5
    

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Correspondence Address:
Serpil Yaylaci
Department of Emergency Medicine, Acibadem University, School of Medicine, Istanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.145408

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