mise à jour du
14 octobre 2007
Retropharyngeal tendinitis:
a rare differential diagnosis
of severe headaches and neck pain
Harnier S, Kuhn J, Harzheim A, Bewermeyer H, Limmroth V
Neurology, University of Cologne


Yawning and stomatology
Retropharyngeal tendinitis is a rare cause of intense neck pain and occipital headache. It is caused by an aseptic inflammatory process in the longus colli tendon, triggered by deposition of calcium hydroxyapatite crystal.
Clinically, it can be misdiagnosed as retropharyngeal abscess, traumatic injury, infectious spondylitis, cervical artery dissection, or even meningitis. The diagnosis is made radiographically by a nearly pathognomonic amorphous calcification anterior to C1-C2 and prevertebral soft tissue swelling. We present a new case of this uncommon condition exhibiting some unusual features.
Acute aseptic tendinitis of the longus colli muscle (retropharyngeal tendinitis) is extremely rare and was first
described by Hartley and Fahlgren in 1964. Due to the typically sub-acute onset of extremely severe neck pain‚ and more seldom headache‚ painful restriction of movement in the cervical spine and increased body temperature, retropharyngeal tendinitis is an important differential diagnosis in patients with secondary headaches and neck pain.
A 38-year-old female patient was admitted to hospital following the occurrence of progressive complaints over the course of only a few days. She reported continual, sharp and diffuse pain at the nape of the neck, which radiated up into the back of the head and was aggravated by head movement.
The patient also complained of swallowing difficulties and excoriating pain during yawning.
No incident of cervical spine trauma was recalled.
An infection of the upper respiratory tract, the pharynx or teeth prior to symptom onset was negated. The patient had been operated on 5-years earlier due to a herniated disc at level C5/C6. A Bryan cervical disc prosthesis had been inserted.
Clinical assessment revealed painful restriction of cervi- cal movement. Neurological status was normal. An elevated leukocyte count 12.8/nL and CRP 91.3 mg/L was established. Extensive laboratory analyses, e.g., rheumatoid factor, ANCA, ANA, revealed normal results. Normal results were also found in the ENT examination for the oral cavity, pharynx, and larynx, ruling out a retropharyngeal abscess.
Cervical spine x-rays showed that the Bryan disc prosthesis was correctly positioned and also revealed kyphosis at C5/C6. Calcification ventral to C2 inferior to the anterior arch of the atlas and a widening of the prevertebral soft tissue shadow was observed. In comparison with outpatient x-rays taken 1 year earlier were not present, x-rays were taken in order to check the position of the inserted Bryan prosthesis), an increase in the amount of calcification was evident.
In accordance with the x-ray images, computer tomography revealed a narrow, band-like and moderate calcification to the right and ventral anterior to the first and second cervical vertebrae. The calcification was located in the very area of the longus colli muscle. MRI revealed hypointensity ventral to C2 and a thin prevertebral hyperin- tense rim of edema. Altogether, the findings resulted in a diagnosis of acute calcifying prevertebral tendinitis.
The patient received antiphlogistic treatment with ibuprofen (500 mg/d t.i.d.). Due to the severity of pain experienced, initial treatment with opioids (100 mg tramadolol/d) and the muscle relaxant benzodiazepine tetrazepam (50 mg/d) was also necessary. This treatment led to a rapid alleviation of symptoms, so that it was possible to discharge the patient only a few days later.
retropharyngitis tendinitis
longus colli muscle