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Retropharyngeal calcific tendinitis in the neurological emergency unit, report of three cases and review of the literature

Tatjana Filipovic
Tatjana Filipovic
 oraz 
Jernej Avsenik
Jernej Avsenik
   | 30 lis 2023
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Article Category: Review
Data publikacji: 30 lis 2023
Zakres stron: 430 - 435
Otrzymano: 04 lip 2023
Przyjęty: 17 sie 2023
DOI: https://doi.org/10.2478/raon-2023-0045
Słowa kluczowe
© 2023 Tatjana Filipovic et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

MRI in a 40-year-old female showed short tau inversion recovery sequence (STIR) hyperintensity in the upper part of her left Longus colli muscle, suggesting an oedema (A), with thin prevertebral effusion on sagittal images (B). After intravenous gadolinium contrast injection, a small area of enhancement was observed in the medial aspect of the muscle (C), but no peripherally enhancing collection to suggest an abscess was present. Diffusion-weighted imaging was normal, excluding the presence of pus (D).
MRI in a 40-year-old female showed short tau inversion recovery sequence (STIR) hyperintensity in the upper part of her left Longus colli muscle, suggesting an oedema (A), with thin prevertebral effusion on sagittal images (B). After intravenous gadolinium contrast injection, a small area of enhancement was observed in the medial aspect of the muscle (C), but no peripherally enhancing collection to suggest an abscess was present. Diffusion-weighted imaging was normal, excluding the presence of pus (D).

FIGURE 2.

STIR (short tau inversion recovery) imaging in sagittal (A) and axial (B) plane demonstrated prevertebral soft tissue swelling and oedema in a 51-year-old female, suggesting retropharyngeal calcific tendinitis as the underlying cause. Calcifications in the medial aspect of the longus colli muscle in front of the C1 arc were noted on computed tomography angiography (CTA) (C), confirming the diagnosis.
STIR (short tau inversion recovery) imaging in sagittal (A) and axial (B) plane demonstrated prevertebral soft tissue swelling and oedema in a 51-year-old female, suggesting retropharyngeal calcific tendinitis as the underlying cause. Calcifications in the medial aspect of the longus colli muscle in front of the C1 arc were noted on computed tomography angiography (CTA) (C), confirming the diagnosis.

FIGURE 3.

Flowchart of article selection.
Flowchart of article selection.

Radiological clues for differential diagnosis

Differential diagnosis
Modality RCT ABSCESS TUMOUR
X-RAY May show calcifications Prevertebral swelling − Prevertebral swelling
CT Calcifications LCM oedema

+Peripheral enhancement

+Lymphadenopathy

+Soft tissue mass (Variable enhancement)

+Lymphadenopathy
MR May suggest calcifications LCM oedema +Diffusion restriction (pus) (Superior contrast resolution)

Results from literature analysis

N %
SPECIALITY REPORTS 112 100
  Otorhinolaryngology (ENT) 32 28.6
  Emergency medicine 26 23.2
  Orthopaedic surgery 24 21.4
  Other 19 17
  Neurology 11 9.8
PATIENTS TOTAL 231 100
  Sex: women:men 121:110 52.4:47.6
  Age (years) 22–78 46.7
  Median
  No comorbidities 224 96
  Acute onset (24–72 hours) 208 91
LEADING SYMPTOMS
  Neck pain 231 100
  Neck immobility 222 96
  Odynophagia 210 91
  Trismus 35 15
  Torticollis 11 5
  Stridor 1 0.4
  Dysarthria 1 0.4
  Vertigo 1 0.4
DIAGNOSTIC WORKUP
  Mild to moderate increase in CRP and/or total leucocyte count 216 93
  CT 111 43
  CT + MR 120 47
  Aspiration biopsy 7 3
DIFFERENTIAL DIAGNOSIS
  Retropharyngeal abscess 134 58
  Spondylodiscitis 28 12
  Meningitis 25 11
  Neck artery dissection 4 1,7
COURSE
  Marked improvement within 2 weeks 221 95

Differential diagnosis of the Retropharyngeal calcific tendinitis (RCT)

Feature RCT Meningitis Abscess Discitis Dissection GON,CH
Neck pain +++ ++ +++ +++ ++ ++
Fever − + + + − −
Photophobia − + − − − −
Nausea − + − − −/+ −
Decreased ROM +++ + (flexion) ++ ++ − −/+
Odynophagia ++/+ − ++ −/+ − −
Long tract signs − − − −/+ + −
eISSN:
1581-3207
Język:
Angielski
Częstotliwość wydawania:
4 razy w roku
Dziedziny czasopisma:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
Kanał RSS czasopisma