Prevertebral tendinitis: How to avoid unnecessary surgical interventions

Abstract

Prevertebral tendinitis should be considered when patients suffer from neck pain, neck stiffness, and globus sensations despite low signs of inflammation in the laboratory report. To confirm the diagnosis, the best imaging feature is magnetic resonance imaging with diffusion-weighted images and apparent diffusion coefficient map.

Differentiation of retropharyngeal calcific tendinitis and retropharyngeal abscess: a case series and review of the literature

“…Whereas radiologists can strictly focus on typical imaging findings of the disease, we assume that for ENT specialists, it is hard to decide against antibiotic treatment, when a patient presents with the typical symptoms of the well-known diagnosis of RA, despite laboratory findings being not indicative for infectious disease. Hammer et al published data from ten patients in an ENT journal, where 50% of the patients were treated with antibiotics under the initial diagnosis of RA [8]. Another publication from an ENT journal presents a comparatively high incidence of antibiotic treatment in 6/8 (75%) patients [7] confirming the assumption that antibiotic treatment is rather overrepresented when the patient first presents to an ENT specialist.…”

“…Besides clinical and laboratory diagnostic results, tomography is needed to confirm RCT and exclude potentially harmful differential diagnoses. Due to its clinical appearance with neck stiffness, painful retroflexion of the neck, subfebrile body temperature, odynophagia and occurrence of pharyngeal edema, RCT can mimic RA and may easily be misdiagnosed with the consequence of overtreatment [8]. In addition, a thickening of the retropharyngeal space with raised fluid content may be radiologically misdiagnosed as abscess formation.…”

“…Approaches to distinguish between RCT and RA or other differential diagnoses, such as spondylodiscitis, based on clinical presentation and laboratory results seem to be successful [ 8 ]. While only mild elevation of WBC, limitation of neck movement and pain are unspecific and cannot differentiate between RCT and RA, endoscopic findings visualizing potential edema of the mucosa are crucial in the clinical differentiation between RCT and RA.…”

“…On T2-weighted MR images, edematous changes of the prevertebral muscles present as signal increase and after contrast administration, the affected muscle and the surrounding tissue demonstrate avid enhancement. Diffusion-weighted imaging may facilitate the differential diagnosis to RA formation [ 8 , 10 ]. While coarse calcification can be seen on MRI, fine-granulated calcifications are more easily detected on CT [ 10 ].…”

Paresthesias of the upper respiratory tract

“…G. Hammer и соавт. [26] выявили у 10 пациентов с КГ тендинит пре-вертебральных мягких тканей и предложили проведение МРТ (диффузно-взвешенное изображение) для улучше-ния диагностики заболевания.…”