Acute neck pain in the ED: Consider longus colli calcific tendinitis vs meningitis

Patel, Tyag; Weis, James C.

doi:10.1016/j.ajem.2017.01.055

Cited by 11 publications

(7 citation statements)

References 4 publications

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“…In a small series, Fryer and Adams [113] found little correlation between the presence of facet arthropathy and the side or level of symptoms in patients with acute, unilateral neck pain. Spondylotic changes on radiographs and MRI are common in patients over 30 years of age and have been shown to correlate poorly with the presence of neck pain [20][21][22][23]114,115]. Okada et al [112], in a 10-year longitudinal MRI study, showed that cervical disc degeneration progressed in 85% of patients, though symptoms developed in only 34% of patients.…”

Section: Radiography Cervical Spinementioning

confidence: 99%

ACR Appropriateness Criteria® Cervical Neck Pain or Cervical Radiculopathy

Imaging¹,

McDonald

Kirsch

et al. 2019

Journal of the American College of Radiology

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Nontraumatic neck pain is a leading cause of disability, with nearly 50% of individuals experiencing ongoing or recurrent symptoms. Radiographs are appropriate as initial imaging for cervical or neck pain in the absence of "red flag" symptoms or if there are unchanging chronic symptoms; however, spondylotic changes are commonly identified and may result in both false-positive and false-negative findings. Noncontrast CT can be complementary to radiographs for evaluation of new or changing symptoms in the setting of prior cervical spine surgery or in the assessment of extent of ossification in the posterior longitudinal ligament. Noncontrast MRI is usually appropriate for assessment of new or increasing radiculopathy due to improved nerve root definition. MRI without and with contrast is usually appropriate in patients with new or increasing cervical or neck pain or radiculopathy in the setting of suspected infection or known malignancy. Imaging may be appropriate; however, it is not always indicated for evaluation of cervicogenic headache without neurologic deficit.

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Section: Radiography Cervical Spinementioning

confidence: 99%

ACR Appropriateness Criteria® Cervical Neck Pain or Cervical Radiculopathy

Imaging¹,

McDonald

Kirsch

et al. 2019

Journal of the American College of Radiology

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“…Despite the insensitivity of MRI to demonstrate calcific deposition within the tendon, it can provide useful information that helps to exclude spondylitis or epidural abscess. [ 2 , 18 , 19 ]…”

Section: Discussionmentioning

confidence: 99%

Case reports about an overlooked cause of neck pain

et al. 2017

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Study Design:Case description.Objective:Acute calcific tendinitis of the longus colli muscle is a rare clinical entity that causes severe neck pain. This entity is not well recognized due to its nonspecific presentation such as acute neck pain, neck stiffness, and odynophagia. The importance of this disease with a review of the literature is presented.Summary of background data:Acute calcific tendinitis of the longus colli muscle is an inflammatory condition caused by deposition of calcium hydroxyapatite in the superior oblique tendon fibers of the longus colli muscle. It can be misdiagnosed as other life-threatening conditions including retropharyngeal abscess, resulting in unnecessary medical or surgical interventions.Methods:We retrospectively reviewed the clinical data, radiological features, and laboratory reports of 8 patients who were diagnosed with acute calcific tendinitis of the longus colli muscle and seen at our institution between April 2008 and March 2015 in this article. We describe the clinical presentation, diagnosis, and treatment of acute calcific tendinitis of the longus colli muscle.Results:There were 5 men and 3 women who ranged in age from 41 to 49 years (mean age: 44.5 years). The associated symptoms included neck pain, stiffness, odynophagia, and headache. The duration of symptoms varied from 2 days to 1 week. All patients showed calcific deposition inferior to the anterior arch of the atlas, and prevertebral effusion extending from C1 to C4. All patients were treated with NSAIDs and immobilization with a cervical brace, and most patients showed complete resolution of symptoms within 1 week.Conclusion:We report 8 cases of acute calcific tendinitis of the longus colli, and describe the symptoms and radiological findings in detail. Awareness of this rare, benign, and self-limiting disease entity with characteristic radiologic findings is essential for early diagnosis and to avoid unnecessary medical and surgical interventions.

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“…[1] Nearly all patients were asymptomatic by 14 days with any of the most commonly utilized treatment methods: NSAIDs, steroids, or opiate analgesics. Although none of the cases evaluated here included headache, there have been other cases of RCT identified with this symptom [2,6] that complicates the initial consideration of RCT in patients.…”

Section: Discussionmentioning

confidence: 99%

Retropharyngeal tendinitis: Hydroxyapatite deposition driven headache and nuchal rigidity resolves with prednisone

Amarnani

Saperstein

McFarlane

et al. 2017

CRIM

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We present a case of a 42-year-old woman who presented with sudden onset severe headache, neck pain, and nuchal rigidity associated with dysphagia. The initial differential in this patient included meningitis or retropharyngeal abscess, and an extracranial neck CT showed an ill-defined hypo-attenuated lesion within the retropharyngeal space. However, the neck pain and dysphagia were unresponsive to empirical antibiotic treatment and pain management. Further CT with contrast identified acute calcific tendonitis of the longus colli tendon, also known as retropharyngeal tendonitis (RCT). Although RCT is already known as a rare, self-limiting inflammatory condition, we present a new case of RCT, with the uncommon features of headache and nuchal rigidity in an aseptic patient, while providing a diagnostic flow chart to guide the clinical work-up of similar presentations to also include RCT.

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Acute neck pain in the ED: Consider longus colli calcific tendinitis vs meningitis

Cited by 11 publications

References 4 publications

ACR Appropriateness Criteria® Cervical Neck Pain or Cervical Radiculopathy

ACR Appropriateness Criteria® Cervical Neck Pain or Cervical Radiculopathy

Case reports about an overlooked cause of neck pain

Retropharyngeal tendinitis: Hydroxyapatite deposition driven headache and nuchal rigidity resolves with prednisone

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