Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; Memorial Hermann-Texas Medical Center, Houston, TX 77030, USA; Lyndon Baines Johnson General Hospital, Houston, TX 77030, USA; The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Am J Emerg Med. 2013 Oct;31(10):1538.e1-2. doi: 10.1016/j.ajem.2013.05.035. Epub 2013 Aug 9.
Numerous pathologies diagnosed in the emergency department (ED) are treated with invasive procedures involving anesthetic and surgical risks. Retropharyngeal abscess is a serious condition requiring emergent treatment, often in need of trans-oral incision and drainage under general anesthesia. A misdiagnosis, especially after surgical treatment, might generate undesirable consequences, more so if the final diagnosis is a non-surgical pathology such as longus colli (LC) tendonitis. To discuss the etiology, differential diagnosis and treatment of LC tendonitis, a clinical condition still misdiagnosed despite advanced imaging techniques. A middle-aged man presented to a satellite ED with sore throat, neck pain and stiffness. A computed tomography (CT) scan of the neck with intravenous contrast was read as retropharyngeal abscess. He was transferred to our ED after acceptance by ear-nose-throat (ENT) surgery. He was scheduled for open incision and drainage under general anesthesia. A detailed evaluation by our ED staff revealed a nontoxic patient with no compromise of the airway. His physical exam was unrevealing and a second review of the CT demonstrated typical radiological signs for LC tendonitis. After a discussion with ENT the patient was discharged home on anti-inflammatory medications and oral steroids. He recovered well and no further intervention was needed. Longus colli tendonitis is a rare condition that mimics emergent surgical conditions. Emergency physicians are qualified to make a clinical and radiological diagnosis. While CT scan can provide a diagnosis, the primary evaluation tool is an adequate medical interview and physical exam.
急诊科（ED）诊断出的许多疾病都需要进行涉及麻醉和手术风险的侵入性治疗。咽后脓肿是一种需要紧急治疗的严重疾病，通常需要在全身麻醉下进行经口切开引流。误诊，尤其是在手术后，可能会产生不良后果，如果最终诊断是非手术性疾病，如颈长肌（LC）肌腱炎，则后果更为严重。为了讨论 LC 肌腱炎的病因、鉴别诊断和治疗，这是一种尽管有先进的成像技术但仍被误诊的临床疾病。一名中年男子因咽痛、颈部疼痛和僵硬到卫星 ED 就诊。颈部静脉注射对比计算机断层扫描（CT）被解读为咽后脓肿。在耳鼻喉科（ENT）手术同意后，他被转至我们的 ED。他被安排在全身麻醉下进行开放性切开引流。我们 ED 工作人员的详细评估显示患者为非中毒性，气道无阻塞。他的体检无明显异常，第二次 CT 检查显示出 LC 肌腱炎的典型放射学征象。在与 ENT 讨论后，患者在家中接受抗炎药物和口服类固醇治疗后出院。他恢复良好，无需进一步干预。颈长肌肌腱炎是一种罕见的疾病，模仿紧急手术情况。急诊医生有能力做出临床和放射学诊断。虽然 CT 扫描可以提供诊断，但主要的评估工具是充分的医疗访谈和体检。
