Korean J Radiol.  2011 Aug;12(4):504-509. 10.3348/kjr.2011.12.4.504.

Acute Retropharyngeal Calcific Tendinitis in an Unusual Location: a Case Report in a Patient with Rheumatoid Arthritis and Atlantoaxial Subluxation

• Lee S
• Joo KB
• Lee KH
• Uhm WS

• KMID: 1783218
• DOI: http://doi.org/10.3348/kjr.2011.12.4.504

Abstract

Retropharyngeal calcific tendinitis is defined as inflammation of the longus colli muscle and is caused by the deposition of calcium hydroxyapatite crystals, which usually involves the superior oblique fibers of the longus colli muscle from C1-3. Diagnosis is usually made by detecting amorphous calcification and prevertebral soft tissue swelling on radiograph, CT or MRI. In this report, we introduce a case of this disease which was misdiagnosed as a retropharyngeal tuberculous abscess, or a muscle strain of the ongus colli muscle. No calcifications were visible along the vertical fibers of the longus colli muscle. The lesion was located anterior to the C4-5 disc, in a rheumatoid arthritis patient with atlantoaxial subluxation. Calcific tendinitis of the longus colli muscle at this location in a rheumatoid arthritis patient has not been reported in the English literature.

Keyword

Calcific tendinitis; Longus colli muscle; Magnetic resonance imaging (MRI); Computed tomography (CT); Rheumatoid arthritis

MeSH Terms

Adult
Arthritis, Rheumatoid/*complications
Atlanto-Axial Joint/*physiopathology
Calcinosis/*complications/*diagnosis
Diagnosis, Differential
Dislocations/*complications
Female
Humans
*Magnetic Resonance Imaging
Pharyngeal Diseases/*complications/*diagnosis
Tendinopathy/*complications/*diagnosis

Figure

• 

  Fig. 1 Acute retropharyngeal calcific tendinitis in 30-year-old woman. A. Initial plain radiograph showing atlantoaxial subluxation (arrows) and prevertebral soft tissue swelling (arrowheads). There is no evidence of calcification along anterior border of the cervical spine. B, C. Sagittal (B) and axial T2-weighted (C) images show prominent prevertebral soft tissue swelling and fluid collection at C1-6 (arrows). D. Axial T1-weighted image at level C1-2 shows bony erosion in odontoid process (arrowhead). E, F. Enhanced sagittal (E) and axial T1-weighted (F) images with fat suppression showing markedly decreased amounts of fluid collection and prevertebral soft tissue swelling (arrows) after just 10 hours. G, H. Sagittal reformatted (G) and axial (H) images showing amorphous calcification (arrows) at right para-midline location anterior to C4-5 disc. I, J. Follow-up sagittal T2-weighted (I) and T1-weighted (J) MR images revealing minimal amounts of fluid collection (arrows) and minor low signal intensity calcification (arrowheads) anterior to C4-5 disc. K. Follow-up sagittal reformatted CT image after two months demonstrating almost complete resolution of calcification anterior to C4-5 disc (arrowhead). L. Anatomical illustration of longus colli muscles and site of retropharyngeal calcific tendinitis.

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