A 40-year-old man presents with acute onset severe neck pain, odynophagia, and low-grade fever. Lateral cervical radiograph shows marked prevertebral soft tissue swelling, and CT reveals amorphous calcification in the superior fibers of the longus colli muscle anterior to C1-C2 without a drainable fluid collection. What is the most likely diagnosis?

• A Retropharyngeal abscess
• B Prevertebral hematoma
• C Acute calcific tendinitis of the longus colli ✓
• D Cervical vertebral osteomyelitis

Explanation

Calcium hydroxyapatite deposition in the superior oblique fibers of the longus colli produces acute pain, odynophagia and fever that mimics infection. Calcification anterior to B1-B2 with reactive prevertebral edema and absence of rim-enhancing fluid confirms it. It is self-limiting and treated with NSAIDs. A retropharyngeal abscess would show a rim-enhancing collection without calcification, which is the single fact that excludes option A.

Reference: Som and Curtin Head and Neck Imaging, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.