At first, a carotid or vertebral artery dissection was considered as the probable diagnosis, but it was excluded by computed tomography (CT) angiography. Neck CT and magnetic resonance imaging (MRI) exams were performed later (Figs. 1, 2) and confirmed the diagnosis of acute calcific tendinitis of the longus colli muscle (ACTLCM). In retrospect, the imaging findings revealed that the characteristic features of ACTLCM had been overlooked on the initial CT angiography exam.

ACTLCM is a rare, self-limited condition characterized by calcium deposition in the superior oblique tendon fibers of the longus colli muscle and a secondary inflammatory reaction. Typical symptoms are acute-onset odynophagia, neck pain, and stiffness; other symptoms include limited cervical range of motion, occipital headache, trismus, and low-grade fever. These symptoms can be misdiagnosed as meningitis or another life-threatening condition such as retropharyngeal abscess or infectious spondylitis. Dysphagia, odynophagia, and the absence of photophobia are clinical aspects more often associated with retropharyngeal processes, and they can help differentiate ACTLCM from meningitis [1]. Specific imaging findings include amorphous calcifications anterior to the C1–C2 vertebrae with adjacent soft-tissue edema and fluid collection in retropharyngeal space and they can help to exclude spondylitis and retropharyngeal abscess. CT and MRI are preferable to radiographs. Treatment includes immobilization, analgesics, and nonsteroidal anti-inflammatory drugs, as well as corticosteroids in severe cases. Symptoms usually resolve within 2 weeks. This patient received analgesics, corticosteroids, and a cervical collar, and the symptoms resolved in 5 days. Early and accurate diagnosis is the key to proper patient management [2–4].