Retropharyngeal Calcific Tendinitis: Case Report and Review of the Literature

Park, Richard; Halpert, Daniel E.; Baer, Alan; Kunar, Dario; Holt, Peter A.

doi:10.1016/j.semarthrit.2009.04.002

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Volume 39, Issue 6 , Pages 504-509, June 2010

Retropharyngeal Calcific Tendinitis: Case Report and Review of the Literature

Richard Park, MD
- Resident, Department of Internal Medicine, Good Samaritan Hospital, Baltimore, MD
Daniel E. Halpert, DO
- Resident, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
Alan Baer, MD
- Associate Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Director, Johns Hopkins University Clinical Practice, Good Samaritan Hospital, Chief of Rheumatology, Good Samaritan Hospital, Baltimore, MD
Dario Kunar, MD, FACS
- Department of Otolaryngology, Greater Baltimore Medical Center, Baltimore, MD
Peter A. Holt, MD
- Associate Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Address reprint requests to Peter A. Holt, MD, Johns Hopkins University School of Medicine, Good Samaritan Hospital, Russell Morgan Building, 5601 Loch Raven Blvd., Suite 509, Baltimore, MD 21239

published online 22 June 2009.

Objectives

Retropharyngeal calcific tendinitis (RCT) is an under-recognized benign condition that results in significant neck pain and may mimic a retropharyngeal abscess (RPA). We describe the clinical presentation, diagnosis, and treatment of RCT as well as features that differentiate it from RPA.

Methods

We present a case report and analyze the clinical features, diagnosis, and treatment of 71 additional patients with RCT identified through a PubMed literature review between 1964 and early 2008. We then compared these findings with those of RPA.

Results

The most common symptoms of RCT at presentation were neck pain (94%), limited range of motion (45%), odynophagia (45%), neck stiffness (42%), dysphagia (27%), sore throat (17%), and neck spasm (11%). Other frequent findings include low-grade fever, mild leukocytosis, and a slightly elevated erythrocyte sedimentation rate. Seventy-five percent of patients with RPA present with similar symptoms and cervical radiographic abnormalities are comparable in the majority of cases with either pathology.

Conclusions

RCT frequently mimics the clinical features of RPA and recognizing the key symptoms and signs of RCT versus RPA can be challenging but important in avoiding unnecessary interventions. We recommend that computed tomography of the neck be considered as a first step in differentiating the 2 conditions. The presence of an amorphous calcification anterior to the C1 and/or C2 vertebral body(s) with a non-ring-enhancing fluid collection in the prevertebral space should be considered highly suspicious for RCT. RCT can be self-limiting and will usually resolve in 2 weeks. Effective treatment typically consists of nonsteroidal anti-inflammatory drugs, steroids, or opiate analgesics.

Keywords: retropharyngeal, tendinitis, abscess, pain, neck