(A203) Acute Calcific Tendonitis of the Longus Colli: A Case Series and Review of the Literature

Introduction: Acute calcific tendonitis of the longus colli muscle (ACTLC) is a non-infectious inflammatory process that is self-limited but can clinically and radiologically mimic deep neck space infection (DNSI), leading to unnecessary antibiotic use, hospital admission, and even surgical treatment. With the existing literature limited to individual case reports and a few case series, our study presents a new series of five ACTLC cases and a comprehensive literature review, analyzing the clinical/radiologic features and treatment of ACTLC, to better define this disease process and facilitate its diagnosis and treatment.

Methods: We performed a retrospective chart review of five patients with ACTLC seen across two institutions between October 2019 and May 2024. Additionally, we performed a literature review of reported cases of ACTLC on Pubmed from inception through January 2025, recording relevant findings for each case. This data was pooled and compared to that of our series.

Results: Of the 5 patients in our series, 5/5 presented with neck pain and limited neck range of motion (ROM), 4/5 presented with odynophagia, and 1/5 were febrile. Flexible laryngoscopy showed posterior pharyngeal wall edema in 1/4. Leukocytosis was present in 1/5; CRP was elevated in 2/2, and ESR was elevated in 2/3. CT showed prevertebral calcification in 5/5 and retropharyngeal effusion/edema in 4/5. Treatment consisted of different combinations of NSAIDs, corticosteroids, and antibiotics, and the average time to symptom resolution was 3.8 days (+/- 2.4).

The literature review yielded 77 case reports and 7 case series with a total of 107 patients. The pooled data from historical cases closely mirrored that of our series.

Conclusions: ACTLC presents with acute neck pain, limited neck ROM, and odynophagia with RP effusion/edema usually seen on CT; elevated inflammatory markers are also common. These findings can mimic DNSI, but the characteristic imaging finding of prevertebral calcification can differentiate the two and prevent unnecessary intervention, as ACTLC is self-limited and typically resolves in a matter of days with supportive treatment.