Pathways in the diagnosis of prevertebral tendinitis

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Abstract

Introduction

The prevertebral tendinitis is an inflammatory process, which affects the cervicothoracic prevertebral muscles. This extremely rare entity was first described by Hartley and Fahlgren in 1964 and until now there are just some case reports dealing with this process.

Unfortunately it is quite easy to misdiagnose or mistake the prevertebral tendinitis 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 to prevent unnecessary surgery.

Material and methods

Six patients with already by imaging or retrospectively after surgery by pathologic report diagnosed prevertebral tendinitis were included in this study. None of these patients suffered from a chronically inflammatory 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 additionally performed diffusion weighted images and calculated the apparent diffusion coefficient (ADC) map.

The laboratory reports obtained on the day of the computed tomography (CT) or magnetic resonance imaging (MRI) examinations were reviewed for C-reactive protein (CRP) and white blood cell count (WBCC).

Results

All patients revealed a prevertebral cervical effusion. Five out of six patients showed amorphous calcifications in the tendon of the prevertebral muscles. In one case calcifications could not be identified at all because of very strong beam hardening artefacts caused by dental prothesis.

The CRP values were increased in all patients (mean value 44.9 mg/l; SD ± 28.3). However, WBCC remained normal (mean value 8.4 G/l; SD ± 2.7).

Only for the two patients who received DWI it was possible to assess the quality of the prevertebral fluid accumulation and to detect the benign prevertebral effusion, which is typical for the retropharyngeal tendinitis.

Conclusion

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 tendinitis.

In some cases MRI might not be available. Here we recommend CT scans to detect typical prevertebral calcifications. Especially a slight elevation of CRP and normal WBCC make the prevertebral tendinitis more likely.

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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1

Tel.: +43 316 385 81348; fax: +43 316 385 13549.

2

Tel.: +43 316 385 80422; fax: +43 316 385 13848.

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