Download - Case of the Month - October 2013
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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
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Contrast Enhanced CT of the Neck
• What are the imaging findings?• What is the differential diagnosis? Diagnosis?
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Sagittal Soft Tissue and Bone Windows
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Axial Soft Tissue Window
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Coronal Soft Tissue Window
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Axial Bone Window
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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.
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Differential Diagnosis
• Retropharyngeal abscess?• Retropharyngeal effusion?• Perivertebral space infection?• Other?
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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.
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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.
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• 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
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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.
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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