Mayo Clinic Department of Emergency Medicine, Phoenix, Arizona and Mayo Clinic Alix School of Medicine, Scottsdale, Arizona.
Mayo Clinic Department of Emergency Medicine, Phoenix, Arizona and Mayo Clinic Alix School of Medicine, Scottsdale, Arizona.
J Emerg Med. 2023 Oct;65(4):e307-e309. doi: 10.1016/j.jemermed.2023.05.023. Epub 2023 Jun 10.
Acute calcific tendinitis (ACT) of the longus colli muscle (LCM) is an inflammatory response due to deposition of calcium hydroxyapatite crystals. It is typically correlated with whiplash and overuse injuries. A common presentation of this inflammatory response is acute but progressive neck pain. It is a rare but important cause of neck pain that should be considered on a differential diagnosis when distinguishing between life-threatening conditions and non-life-threatening causes of neck pain.
A 51-year-old woman presented to the emergency department (ED) reporting a mild sore throat that progressed to acute neck pain and stiffness. She also reported fatigue, fever, myalgias, and nausea. In the ED, the patient was tachycardic, hypertensive, and mildly febrile with normal oxygen saturation. Examination revealed meningismus and was negative for lymphadenopathy, oropharyngeal findings, and neurologic deficits. Laboratory studies were significant for leukocytosis. Computed tomography (CT) neck was obtained and was notable for calcification of the superior left longus colli muscle with prevertebral and retropharyngeal space edema along the muscle body. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ACT of the LCM is a benign, self-limited condition that can present with features overlapping emergent causes of acute neck pain. Correct diagnosis relies on characteristic radiographic findings on CT. Fortunately, patients may be discharged home with a short course of anti-inflammatories and corticosteroids with near-complete resolution of symptoms. Emergency physicians, therefore, can rule out life-threatening causes of neck pain, while also making a definitive diagnosis and initiating effective management for this pathology.
长颈肌急性钙化性肌腱炎（ACT）是由于羟磷灰石钙晶体沉积引起的炎症反应。它通常与挥鞭伤和过度使用损伤有关。这种炎症反应的常见表现是急性但逐渐加重的颈部疼痛。这是一种罕见但重要的颈部疼痛原因，在鉴别威胁生命和非威胁生命的颈部疼痛原因时，应作为鉴别诊断考虑。
一名 51 岁女性因轻度咽痛就诊于急诊科，症状逐渐加重为急性颈部疼痛和僵硬。她还报告疲劳、发热、肌痛和恶心。在急诊科，患者心动过速、高血压和轻度发热，血氧饱和度正常。检查发现脑膜刺激征，无淋巴结病、咽腔发现或神经功能缺损。实验室研究发现白细胞增多。进行了颈部计算机断层扫描（CT），结果显示左上长颈肌的钙化，伴有椎体前和咽后间隙肌肉体水肿。
为什么急诊医生应该注意到这一点？：LCM 的 ACT 是一种良性、自限性疾病，其表现可能与急性颈部疼痛的紧急原因重叠。正确的诊断依赖于 CT 上的特征性影像学发现。幸运的是，患者可能在家中接受短期抗炎和皮质类固醇治疗，症状几乎完全缓解。因此，急诊医生可以排除威胁生命的颈部疼痛原因，同时对该病理进行明确诊断和有效治疗。
