Tamami Shirakawa1, Kazutoshi Inamura2, Yasuhisa Tanaka3, Takeshi Hoshikawa3, Megumi Kuchiki1, and Atsuko Oda1
1Radiology, Tohoku Central Hospital, Yamagata, Japan, 2Otolaryngology, Tohoku Central Hospital, Yamagata, Japan, 3Orthopaedic Surgery, Tohoku Central Hospital, Yamagata, Japan
Synopsis
Calcific longus colli tendinitis is an inflammatory
lesion in the prevertebral space. When prevertebral effusion is observed on MRI,
awareness of the prevertebral muscle swelling with signal change and the
associated mass effect would suggest that the main site of the lesion is the prevertebral
space, not the retropharyngeal space and may thus prevent both misdiagnosis as a
retropharyngeal abscess and unnecessary treatment. The variability in the level
of calcification and prevertebral effusion is highlighted in the present study
in order to assist in the establishment of the correct radiological diagnosis.Purpose
The purposes of our poster are to:
(1)
demonstrate characteristic imaging findings of calcific longus colli tendinitis
and
(2) emphasize recognition of the pathognomonic imaging appearance in order to
prevent misdiagnosis and unnecessary treatment.
Outline of Content
Calcific
longus colli tendinitis is an uncommon disease involving inflammation caused by
deposition of calcium hydroxyapatite crystals in the longus colli muscle.
Symptoms include neck pain, limited neck movement, and odynophagia. CT demonstrates
prevertebral calcification as well as effusion or edema and is the typical
imaging modality used to exclude retropharyngeal abscess from the differential
diagnosis. On the other hand, MRI of the cervical spine is often the initial
imaging modality for suspected spinal disease. Therefore, recognition of calcific
longus colli tendinitis and an understanding of the diagnostic criteria for
this disease on MRI are important.
MRI
examinations of the cervical spine totaled more than 8000 between June 2005 and
September 2015 in our hospital. Three patients had findings consistent with calcific
longus colli tendinitis. Short inversion time inversion recovery (STIR) images were useful in demonstrating the
increased signal intensity in the swollen prevertebral muscles as well as
prevertebral effusion (Fig. 1-3). The longus capitis muscle was
displaced anteriorly by effusion and swelling of the longus colli muscle (Fig.
1). Hypointense signal anterior to the vertebra corresponded to calcification
on CT and plain radiograph (Fig. 1-3). One patient presented with the
typical location of calcification anterior to C1-C2 involving the superior
oblique fibers of the longus colli muscle (Fig. 1). Two patients presented with
unusual locations of calcification anterior to C3-C4 and C5-C6 level,
respectively (Fig. 2, 3). Calcium deposition anterior to C3-C4 and C5-C6 was thought
to involve the vertical fibers of the longus colli muscle.
Summary
The most important elements in the successful
establishment of the diagnosis of calcific longus colli tendinitis include the recognition
of the existence of this disease and the awareness of its characteristic appearance
on radiological imaging modalities.
When prevertebral effusion is present on MRI,
awareness of prevertebral muscle swelling with signal change and the related mass
effect suggests the possibility of calcific longus colli tendinitis. The
variability in the level of calcification and prevertebral effusion are highlighted
in the present study in order to assist in the establishment of the correct
radiological diagnosis.
Acknowledgements
No acknowledgement found.References
No reference found.