Acute Calcific Retropharyngeal Tendinitis

Darshana A. Sanghvi, MD
Bhavin G. Jankharia, MD
Nilendu C. Purandare, DNB
Murali Sundaram, MD

Diagnosis: Acute Calcific Retropharyngeal Tendinitis

Acute calcific retropharyngeal tendinitis or longus colli tendinitis, caused by hydroxyapatite crystal deposition in the tendinous insertion of the longus colli muscle, often is an unrecognized cause of acute to subacute neck pain that typically occurs in the third through sixth decades of life and usually presents as the triad of neck pain, odynophagia, and fever. Laboratory evaluation often reveals a low-grade leukocytosis and an elevated sedimentation rate, raising the suspicion of more ominous diagnoses such as retropharyngeal abscess and malignancy.

This clinical syndrome was fi rst described by Hartley¹ in 1964. Ring et al² in 1994 reported five patients in whom an initial misdiagnosis of this entity as a retropharyngeal or nasopharyngeal abscess, a neoplasm, or a fracture-dislocation of the cervical spine led to interventions such as hospital admission and parenteral administration of antibiotics. An open biopsy was performed in one patient because of a suspected neoplasm, and pathological evaluation demonstrated a foreign- body inflammatory response to deposited crystals of hydroxyapatite. In all five patients, the correct diagnosis was established only after retrospective review of the radiographic studies by a physician who was familiar with acute calcific retropharyngeal tendinitis.

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