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Acute calcific tendinitis of the longus colli muscle: an often unrecognized cause of severe neck pain.

Acute calcific tendinitis of the longus colli muscle is an inflammatory process that may result in acute neck and occipital pain, rigidity, and dysphagia. Low-grade fever, leucocytosis, and elevated erythrocyte sedimentation rate can be present. Differential diagnosis should include a retropharyngeal abscess or hematoma, traumatic injury, infectious spondylitis, or even meningitis. Diagnosis can be made radiographically with computed tomography (CT) or magnetic resonance imaging (MRI). A typical finding is calcification anteriorly mostly to C1–C2 and retropharyngeal swelling. This typical finding on MRI or CT can discriminate between acute calcific tendinitis of the longus colli muscle and more serious diseases that require drainage or parenteral antibiotics treatment. A conventional x-ray can overlook subtle calcifications. MRI is better in detection of swelling and inflammation, whereas CT is better in detection of calcification. For the diagnosis of acute calcific tendinitis of the longus colli muscle, one needs to identify both swelling and calcification. MRI can also discriminate from an abscess and an infectious spondylitis, so MRI is probably the best imaging for establishing the diagnosis of acute neck pain. Treatment concentrates on pain allevation, using nonsteroidal anti-inflammatory drugs. The pathogenesis includes deposition of calcium-hydroxyapatite crystals in the tendon with rupturing, producing inflammation and therefore swelling and acute pain, rigidity, and sometimes dysphagia. Resorption of calcification after the acute stage is common, and this resorption may be complete after 1 to 2 weeks, with disappearence of the soft tissue swelling and the symptoms. The cause is unclear, some reports mention trauma or upper respiratory tract infections. In the current case, repetitive movements by playing the violin could be a trigger. Middle-aged individuals of either gender are typically affected. Acute calcific tendinitis of the longus colli muscle is a very rare diagnosis, compared with calcium-hydroxyapatite tendinitis, for example, in the shoulder. Why the tendon of the longus colli muscle is so rarely affected is unknown, possibly this disease is underdiagnosed. Up to now a few case reports have been published in the English literature about this specific disease. We describe a report of a violin player female with severe neck pain.