The great mimic of retropharyngeal abscess: Calcific tendinitis of the longus colli

Background Acute calcific tendinitis of the longus colli (ACTLC) is a benign, self-limiting inflammatory condition caused by calcium hydroxyapatite crystal deposition within the longus colli tendon. It commonly presents with acute neck pain, neck stiffness and odynophagia. Because its clinical and radiographic presentation can mimic a retropharyngeal abscess, it is frequently misdiagnosed, potentially leading to unnecessary antibiotic therapy or invasive surgical drainage. Case Report We present the case of a 55-year-old female who presented with acute neck pain and odynophagia. Computed tomography (CT) of the neck showed a moderate-sized retropharyngeal effusion with new calcific tendinitis of the right longus colli muscle, consistent with ACTLC. The patient was treated conservatively with a short course of oral prednisone and a muscle relaxant, resulting in symptom improvement. Why should an emergency physician be aware of this? This case highlights the importance of recognizing the characteristic CT findings of ACTLC and considering this diagnosis in patients presenting with symptoms suggestive of a retropharyngeal abscess to prevent unnecessary invasive procedures or interventions.