little is known about longus colli tendinitis ( lct ) , a rare inflammatory condition believed to be caused by the deposition of calcium hydroxyapatite crystals in the longus colli muscle .
also known as calcific tendinitis of the longus colli muscle or retropharyngeal tendinitis , lct is characterized by the acute presentation of severe neck pain , dysphagia , torticollis , and/or a painful restriction of neck movement .
its presentation may resemble more serious conditions requiring immediate treatment , such as meningitis , retropharyngeal abscess , foreign body aspiration , or traumatic injury .
patients also typically present with mild leukocytosis , which should prompt investigation to first rule out infectious etiologies .
characteristic radiographic findings of the neck include calcifications in the superior longus colli muscle tendons at the level of c1 or c2 , which confirm the diagnosis .
the incidence of lct has been reported to be 1.31 per 100,000 person - years but may actually be higher due to the belief that the disorder is underdiagnosed .
therefore , we would like to make practitioners aware that lct is an important etiology for neck pain that must always be included in the differential diagnosis for acute neck symptomatology .
a 44-year - old female patient with a history of gastric ulcers , gastritis , gastric polyps , schatzki ring , and hiatal hernia presented with the complaint of progressive dysphagia to solid foods .
this dysphagia first developed after an incident of food aspiration 4 weeks prior to presentation .
three weeks after this event , she experienced persistent odynophagia with left - sided occipital headaches and neck pain radiating to the left ear and mastoid process .
physical examination was remarkable for decreased neck range of motion with flexion and extension and bilateral neck soft tissue tenderness to palpation .
after an infectious etiology had been ruled out , an upper gastrointestinal series with barium swallow confirmed the patient 's known schatzki ring and hiatal hernia .
a ct scan , mri , and mra of the brain were negative for abnormalities ; however , a ct scan of her neck was positive for calcified longus colli tendons just interior to the anterior ring of her c1 vertebrae ( fig 1 , fig 2 ) .
the patient underwent a trial of oral nonsteroidal anti - inflammatory drugs ( nsaids ) and corticosteroids that quickly improved her dysphagia and odynophagia , which soon also resolved .
this case presentation emphasizes the importance of having a vast differential diagnosis for relatively common complaints , such as neck pain and dysphagia .
it is important to carefully contemplate these differentials in order to not misdiagnose less common yet benign etiologies for these complaints , such as lct .
the longus colli muscle is a prevertebral muscle of the anterior neck that consists of a superior oblique , inferior oblique , and vertical portion .
the longus colli muscle assists in cervical flexion and ipsilateral side - bending and rotation .
the mean annual crude incidence of lct was found to be 0.50 cases per 100,000 person - years , with a standardized incidence of 1.31 for the age - matched population .
it most commonly affects both males and females between the ages of 30 and 60 years , as seen in our 44-year - old female .
the pathophysiology behind lct is explained by a reactive inflammatory process induced by calcium hydroxyapatite crystal deposition on the longus colli tendon .
these calcifications , which are usually present in the superior oblique portion of the longus colli muscle at the c1c2 levels , are the cause of symptom development .
the most common presenting symptoms are neck pain ( 94% ) , limited neck range of motion ( 45% ) , odynophagia ( 45% ) , neck stiffness ( 42% ) , dysphagia ( 27% ) , sore throat ( 17% ) , and neck spasm ( 11% ) .
our patient displayed all of these signs and symptoms except for sore throat and neck spasm .
laboratory findings typically include mildly elevated white blood cell count , erythrocyte sedimentation rate , and c - reactive protein , but this case featured only an isolated white blood cell count of 11.88 .
ct is the gold standard for diagnosing lct , as it is readily available and can detect both prevertebral edema and calcium hydroxyapatite crystal deposition at the longus colli tendon [ 4 , 7 ] .
mri can show prevertebral edema and corresponding effusion , but it is difficult to recognize calcific deposits [ 4 , 7 , 8 ] .
this patient demonstrated longus colli calcifications in the anterior ring of the c1 vertebrae found on ct .
the differential diagnosis between lct and other diseases showing similar clinical features includes meningitis , retropharyngeal abscess , neoplasm , cervical disc herniation , and traumatic fracture dislocation .
the most important mimickers of lct are meningitis and retropharyngeal abscess [ 4 , 7 ] .
it is critical to thoroughly work up the case in order to make a correct initial diagnosis and avoid unnecessary interventions . unlike meningitis and
retropharyngeal abscesses , which are often associated with high morbidity , antibiotics use , and surgical intervention , lct is a benign , self - limiting disease .
nsaids are the first - line treatment for lct and often alleviate symptoms , but in severe cases , corticosteroids and opioids may be necessary to abate acute symptom exacerbations [ 4 , 6 , 8 ] .
symptoms typically resolve within a few days of treatment initiation , and the patient often becomes symptom - free after 13 weeks [ 6 , 9 ] .
our patient required both oral nsaids and corticosteroids , which quickly improved her dysphagia and odynophagia within 1 day of treatment initiation .
lct is a rare , unusual clinical entity believed to be underdiagnosed due to its often nonspecific presentation .
increased awareness of the disease and its progressive presentation would perhaps yield more timely identification to avoid diagnostic errors and unnecessary patient and physician anxiety .
therefore , it is imperative that practitioners be aware of lct as an important etiology for various presentations of unexplainable neck pain , dysphagia , and odynophagia .
dominic m. colella and fiorela caldern sandoval wrote the manuscript , david w. powers and nimal patel revised the manuscript , and javier sobrado critically revised the manuscript and is the guarantor .
 longus colli tendinitis ( lct ) is an acute inflammatory condition with symptoms typically consisting of acute neck pain and stiffness with or without dysphagia . 
 once more severe etiologies for these symptoms are ruled out , this self - limiting condition usually resolves spontaneously with nonsteroidal anti - inflammatory drugs and corticosteroids . 
 we present a case of lct that presented as acute neck pain , dysphagia , and odynophagia that rapidly resolved once diagnosed and treated with anti - inflammatory agents . 
 though exceedingly rare , lct must be considered in the differential diagnosis of acute neck pain , dysphagia , and odynophagia when more common etiologies do not correlate with the clinical presentation . 
Introduction
Case Report
Discussion
Author Contributions
Statement of Ethics
Disclosure Statement