Acute calcific retropharyngcal tendinitis is a rare form of calcific periarthritis characterized by acute pain and stiffness in the upper neck associated with a transient calcific deposit in the tendon of the longus colli muscle (1-10). The condition has recently received attention in radiology and otolaryngology publications but, to our knowledge, no reports of the subject exist in the rheumatology literature.We present our experience with I patient to highlight the clinical and radiographic features of this little-known, self-limiting disorder.Case report. A 42-year-old man came to the emergency room in August 1983, with pain and stiffness of the neck of 2 days' duration. The pain was predominantly in the upper cervical region with radiation over the occiput. There was no history of recent illness or trauma. Results of physical examination were normal, except for painful restriction of neck movements and tenderness over the upper cervical spine. Cervical spine radiographs were reported as "negative." A diagnosis of muscle spasm was made, and he was sent home with a collar and analgesic medication.Over the next 2 days, the neck pain became more intense, and he was admitted to the hospital. He was unable to move his head without severe pain, and he complained of pain in the throat upon swallowing. Cervical spine movements were markedly restricted, and tenderness was present over C2 and C3 spinous processes with spasm of the posterior and lateral cervical muscles. There was swelling in the posterior region of the nasopharynx without tenderness or erythema. Initial diagnostic considerations included vertebral osteomyelitis and retropharyngeal cellulitis.Review of the initial radiographs taken 2 days earlier revealed a large amorphous calcific deposit anterior to the C2 vertebra (Figure 1). Repeat lateral films on admission demonstrated partial resolution of the calcific deposit, and significant soft tissue swelling anterior to the vertebral bodies of CI to C4 (Figure 2). N o areas of increased uptake were noted in the cervical spine on bone scanning.Findings from the following laboratory tests were either normal or ncgative: complete blood count, serum calcium, phosphorus, alkaline phosphatase, uric acid, creatinine, urinalysis, rheumatoid factor, antinuclear antibodies, blood and throat cultures. The erythrocyte sedimentation rate (ESR) was 41 p d h o u r . The diagnosis of acute retropharyngcal calcific tendinitis was made, and he was treated with indomethacin and a cervical collar.The neck pain, stiffness, and dysphagia resolved within 3 days, and the ESR returned to normal in 2 weeks. Serial radiographs showed resolution of the prevertebral soft tissue swelling in 1 week, and complete resorption of the amorphous calcification in 6 weeks (Figure 3 ) .Discussion. The clinical picture of acute calcific retropharyngeal tendinitis is similar to acute calcific periarthritis/tendinitis in other sites (1 1-13). Calcification in this disorder is thought to occur in the tendon of the longus colli muscle near its attachm...
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