Pathways in the diagnosis of prevertebral tendinitis
Introduction
Acute calcific tendinitis of the longus colli muscle is an extremely rare self-limiting inflammatory disease. It was first described by Hartley and Fahlgren in 1964 [1] and now goes under a number of synonyms like prevertebral or retroharyngeal tendinitis. We prefer the name prevertebral tendinitis because of the anatomic localization of inflammatory changes. Calcium hydroxyapatite deposition in the longus colli tendon is postulated to induce acute inflammation of the longus colli muscle tendon insertion [2].
Unfortunately it is quite easy to misdiagnose or mistake this rare entity as an abscess, because of the imaging features.
The aim of this case series is to offer guidelines in the diagnosis of this rare disease and to prevent unnecessary surgery.
Section snippets
Materials and methods
Six patients with already by imaging or retrospectively diagnosed retropharyngeal tendinitis were included in this study. There were three male and three female patients with a mean age of 46.3 years (SD ± 14.15). None of these patients suffered from a chronically inflammatory or malignant disease.
Three patients just received contrast enhanced computed tomography (CT) and another group of three patients received magnetic resonance imaging (MRI). In two out of three MRI examinations, we
Results
In two out of three patients, who received CT examinations, the prevertebral inflammatory changes were misdiagnosed as an abscess. This diagnosis was corrected retrospectively after surgery by pathologic report.
All patients revealed a prevertebral effusion (Fig. 1, Fig. 2). According to the pathologic report, we could offer in two cases after surgery, this fluid accumulation consists of serous and fibrinous components.
Five out of six patients showed amorphous calcifications (Fig. 3, Fig. 4) in
Discussion
The anterior vertebral muscles in the neck are the longus colli, longus capitis, rectus capitis anterior, and rectus capitis lateralis. The longus colli muscle consists of the superior oblique, vertical, and inferior oblique fibers [3].
The superior oblique fibers originate from the anterior tubercles of the transverse processes of C3–C5 and insert by a tendon into the anterior tubercle on the ventral arch of the atlas. The vertical fibers arise from the bodies of C5–T3 and insert into the
Conclusion
The prevertebral tendinitis can easily be mistaken as an abscess in CT scans. However, it is necessary to make a clear diagnosis to avoid unnecessary surgery. According to the experience with our patients the best imaging feature is MRI with DWI and ADC map to reveal the benign prevertebral effusion and confirm the diagnosis of prevertebral tendinits.
In some cases MRI might not be available. Here we recommend CT scans to detect typical prevertebral calcifications. Especially a slight elevation
Conflict of interest statement
The authors or authors’ institutions have no conflicts of interest.
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