Retropharyngeal Calcific Tendinitis Mimicking a Retropharyngeal Phlegmon

Background. Acute retropharyngeal tendinitis is a little known but not an uncommon condition. It was first described by Hartley in 1964 as an inflammation of the longus colli muscle secondary to calcium crystals deposition on its insertion. The calcifications are mostly located on the oblique portion of the muscle at the level of C1-C2. Methods. We will describe this disease through 4 cases that presented in our institution. Results. The most common symptoms are severe neck pain, odynophagia, and a painful restriction of neck movement. It is associated with mild fever and inflammatory lab findings such as a slight elevation of white blood cell count, erythrocyte sedimentation rate, and C-reactive protein. CT scan is recommended as the first-line imaging modality to establish a diagnosis. Treatments consist of NSAIDs and analgesics to accelerate the healing process. If symptoms are severe, a course of corticosteroids is required. Conclusion. Since the clinical and laboratory findings of this condition and those of a retropharyngeal abscess overlap, it is important to establish the right diagnosis in order to prevent more invasive procedures. A good knowledge of this clinical entity by otolaryngologists would prevent delays in hospital discharge and unnecessary anxiety. 1. Introduction Acute retropharyngeal tendinitis is a rare condition first described by Hartley in 1964 as an acute inflammation of the longus colli muscle secondary to calcium crystals deposition on the insertion of the muscle [1]. It is characterized by an acute onset of severe neck pain, odynophagia, and a painful restriction of neck movement. The presentation of this disease may be similar to more serious conditions such as retropharyngeal abscess, meningitis, cervical myopathy, and traumatic injury. Thus, knowledge of this condition by Otolaryngologists can prevent misdirected medical therapy, unnecessary invasive procedures, undue anxiety, and delays in hospital discharge. We describe herein 4 cases of retropharyngeal calcific tendinitis that presented in our institution. 2. Case 1 A 63-year-old man presented with a 1-week history of sharp neck pain exacerbated by physical effort, odynophagia, and restricted neck movement in all directions. The flexible endoscopic examination revealed a swelling of the posterior wall of the nasopharynx with diffuse erythema. There was no pus or any suspicious lesions. Oropharynx, hypopharynx, and larynx were normal. His laboratory values included slight leukocytosis and an elevated C-reactive protein. On the same day, a cervical radiography and a