ACUTE CALCIFIC RETROPHARYNGEAL TENDINITIS - CLINICAL PRESENTATION ANDPATHOLOGICAL CHARACTERIZATION

Acute calcific retropharyngeal tendinitis is an underrecognized cause of pain and stiffness in the neck associated with odynophagia and retr opharyngeal soft-tissue swelling. We report on five patients in whom a n initial misdiagnosis of this entity as a retropharyngeal or nasophar yngeal abscess, a neoplasm, or a fracture-dislocation of the cervical spine led to interventions such as admission to the hospital and paren teral administration of antibiotics. An open biopsy was performed in o ne patient because of a suspected neoplasm. Evaluation of the tissue s pecimen with routine and polarized light microscopy, scanning electron microscopy, and energy-dispersive spectrometry demonstrated a foreign -body inflammatory response to deposited crystals of hydroxyapatite. I n all five patients, the correct diagnosis was established only after retrospective review of the radiographic studies by a physician who wa s familiar with acute calcific retropharyngeal tendinitis. The compute d tomographic findings of acute calcific retropharyngeal tendinitis ar e distinctive and consist of prevertebral calcification localized to t he insertion of an edematous tendon of the longus colli muscle. Sympto matic relief was provided with anti-inflammatory and analgesic medicat ions. The symptoms resolved, without sequelae, within one to two weeks for all of the patients. We hope that an increased awareness of hydro xyapatite deposition in the tendon of the longus colli muscle will res ult in improved early diagnosis of acute calcific retropharyngeal tend initis.