
==== Front
J Am Coll Emerg Physicians Open
J Am Coll Emerg Physicians Open
10.1002/(ISSN)2688-1152
EMP2
Journal of the American College of Emergency Physicians Open
2688-1152
John Wiley and Sons Inc. Hoboken

10.1002/emp2.13276
EMP213276
Images in Emergency Medicine
Images in Emergency Medicine
Man with severe neck pain
YAMAGUCHI et al.
Yamaguchi Sho MD https://orcid.org/0009-0008-0194-6195
1 s_yamaguchi8110@icloud.com

Kitai Yuya MD 1
Inoue Tetsuya MD, PhD 1
1 Department of Emergency Medicine Nerima Hikarigaoka Hospital, Nerima Tokyo Japan
* Correspondence
Sho Yamaguchi, Department of Emergency Medicine, Nerima Hikarigaoka Hospital, 2‐5‐1 Hikarigaoka, Nerima, Tokyo, 179‐0072, Japan.
Email: s_yamaguchi8110@icloud.com

17 9 2024
10 2024
5 5 10.1002/emp2.v5.5 e1327622 7 2024
05 8 2024
© 2024 The Author(s). Journal of the American College of Emergency Physicians Open published by Wiley Periodicals, Inc. on behalf of American College of Emergency Physicians.
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

longus colli calcific tendinitis
neck pain
orthopedics
retropharyngeal calcific tendinitis
source-schema-version-number2.0
cover-dateOctober 2024
details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.4.8 mode:remove_FC converted:17.09.2024
Yamaguchi S , Kitai Y , Inoue T . Man with severe neck pain. JACEP Open. 2024;5 :e13276. 10.1002/emp2.13276
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pmc1 CASE PRESENTATION

A 53‐year‐old male presented with acute neck pain radiating to the occiput for 2 days. He had been playing golf daily before symptom onset. There was no history of recent upper respiratory infection. Examination revealed an axillary temperature of 37.4°C, with other vital signs normal. The patient was alert with no meningeal signs, and neck pain worsened with rotation. Neurological examination was normal, with no palpable lymphadenopathy, and the pharyngeal examination was normal. Computed tomography (CT) confirmed the diagnosis (Figure 1).

FIGURE 1 A sagittal (A) and axial (B) unenhanced computed tomography scan showing calcifications anterior to the C1‐C2 vertebrae (white arrows).

2 DIAGNOSIS

2.1 Longus colli calcific tendinitis

CT revealed calcifications anterior to the C1‐C2 vertebrae. Conservative treatment with non‐steroidal anti‐inflammatory drugs (NSAIDs) and rest resulted in gradual symptom improvement, with complete resolution of symptoms ten days post‐presentation.

Longus colli calcific tendinitis is a self‐limiting condition characterized by acute neck pain and prevertebral calcifications. 1 It is often underdiagnosed due to nonspecific symptoms and its self‐limiting nature. 2 The etiology involves calcium hydroxyapatite deposition in the longus colli tendon, often related to repetitive trauma, ischemia, necrosis, and tendinous degeneration. 3 Clinical presentation includes acute neck pain, dysphagia, limited motion, low‐grade fever, and mild leukocytosis. 1 Radiographic findings, such as amorphous calcifications anterior to the cervical vertebrae, are crucial for diagnosis. 3 This benign condition can mimic more serious disorders such as meningitis, retropharyngeal abscess, neoplasm, cervical disc herniation, and fracture dislocation, leading to potential misdiagnosis and unnecessary interventions. 2 Conservative treatment with NSAIDs and rest typically resolves symptoms within 2 weeks. 1 Clinicians should recognize this condition to avoid unnecessary tests and reassure patients by explaining its benign nature.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

ACKNOWLEDGMENTS

The authors thank the administrative staff at their hospital for assistance with editing the manuscript.
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REFERENCES

1 Park R , Halpert DE , Baer A , et al. Retropharyngeal calcific tendinitis: case report and review of the literature. Semin Arthritis Rheum. 2010;39 :504‐509.19540570
2 Horowitz G , Ben‐Ari O , Brenner A , et al. Incidence of retropharyngeal calcific tendinitis (longus colli tendinitis) in the general population. Otolaryngol Head Neck Surg. 2013;148 :955‐958.23525848
3 Zibis AH , Giannis D , Malizos KN , et al. Acute calcific tendinitis of the longus colli muscle: case report and review of the literature. Eur Spine J. 2013;22 (Suppl 3 ):S434‐S438.23179983
