1. Case of the Month - October 2013 • 50 year old male with 2 week history of dysphagia and odynophagia. No trauma. • Investigations reveal: • Temperature 37.5 • WBC normal • C-spine X-rays reveal prevertebral soft tissue swelling. Case submitted by YoanKagoma, PGY2

2. Contrast Enhanced CT of the Neck • What are the imaging findings? • What is the differential diagnosis? Diagnosis?

3. Sagittal Soft Tissue and Bone Windows

4. Axial Soft Tissue Window

5. Coronal Soft Tissue Window

6. Axial Bone Window

7. Findings • Smooth soft tissue edema and swelling within the prevertebral soft tissues from C1-C4 • No evidence of peripheral enhancement. • Amorphous soft tissue calcifications surrounding the atlanto-axial joint.

8. Differential Diagnosis • Retropharyngeal abscess? • Retropharyngeal effusion? • Perivertebralspace infection? • Other?

9. Diagnosis • Findings are most in keeping with calcific tendonitis of the longuscolli muscle. • Infection or retropharyngeal abcess are less likely given that the patient is not febrile, has a normal white count, and the collection does not exhibit peripheral enhancement.

10. Discussion • A rare diagnosis; first described by Hartley in 1964. • Clinical presentation: dysphagia, odynophagia, subacute neck pain, and low grade pyrexia. There may be preceding URTI or minor neck trauma. • Demographics: Most common amongst 30-60 year olds. No male/female predominance.

11. Discussion • Pathophysiology: granulomatousand/or inflammatory reaction due to deposition of calcium hydroxyapatite crystals within the fibers of the longuscolli that insert into C1/C2. • Treatment: anti-inflammatory and analgesic medications. Incision and drainage is NOT required.

12. Discussion The 3 imaging findings most suggestive of the diagnosis: • Amorphous calcifications in the prevertebral muscles, particularly C1-C2 • Inflammation with swelling of prevertebral muscles • Smoothly expanding retropharyngeal space edema Image from Offiah C & Hall E. British Journal of Radiology. 2009 (82): e117-3121.

13. References • Acute calcifictendinitis of the longuscolli muscle: spectrum of CT appearances and anatomical correlation. Offiah C & Hall E. British Journal of Radiology. 2009 (82): e117-3121. • Retropharyngeal Effusion in Acute CalcificPrevertebral Tendinitis: Diagnosis with CT and MR Imaging. Eastwood J et al. American Journal of Neuroradiology. October 1998 (19): 1789-1792. • Acute cervical pain associated with retropharyngeal calcium deposit: a case report. Harley J. Journal of Bone and Joint Surgery. 1964 (46-A):1753–1754. • StatDx – Acute Calcific tendonitis of the longuscolli