title: Acute severe neck pain and dysphagia following cervical maneuver: diagnostic approach.
abstract: BACKGROUND
  Overlooking an etiologic hypothesis in acute neck pain with dysphagia may lead to misdiagnosis.
  
  
  METHODS
  A 51-year-old man who had received cervical manipulation came to the emergency unit with evolutive acute neck pain, cervical spine stiffness and odynophagia, without fever or other signs of identified pathology. Cervical X-ray and CT angiography of the supra-aortic vessels ruled out traumatic etiology (fracture or arterial dissection) and revealed an accessory bone, orienting diagnosis toward retropharyngeal abscess, which was, however, belied by endoscopy performed under general anesthesia. A second CT scan with contrast injection and tissue phase ruled out infection, revealing a retropharyngeal calcification inducing retropharyngeal edema. Evolution under analgesics was favorable within 13 days.
  
  
  CONCLUSIONS
  Given a clinical triad associating acute neck pain, cervical spine stiffness and odynophagia, traumatic or infectious etiology was initially suspected. Cervical CT diagnosed calcific tendinitis of the longus colli, revealing a pathognomic retropharyngeal calcification. Secondary to hydroxyapatite deposits anterior to the odontoid process of the axis, this is a rare form of tendinopathy, usually showing favorable evolution in 10-15 days under analgesic and anti-inflammatory treatment.
authors.affiliation: Service d'ORL et chirurgie cervico-faciale, hôpital d'instruction des armées Legouest, 27, avenue de Plantières, BP 90001, 57077 Metz cedex 3, France. Electronic address: domstrend@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Trendel
authors.affiliation: Service d'ORL et chirurgie cervico-faciale, hôpital d'instruction des armées Legouest, 27, avenue de Plantières, BP 90001, 57077 Metz cedex 3, France.
authors.forename: G
authors.initials: G
authors.lastname: Bonfort
authors.affiliation: Service d'imagerie médicale, hôpital d'instruction des armées Legouest, 27, avenue de Plantières, BP 90001, 57077 Metz cedex 3, France.
authors.forename: M
authors.initials: M
authors.lastname: Lapierre-Combes
authors.affiliation: Service d'ORL et chirurgie cervico-faciale, hôpital d'instruction des armées Legouest, 27, avenue de Plantières, BP 90001, 57077 Metz cedex 3, France.
authors.forename: E
authors.initials: E
authors.lastname: Salf
authors.affiliation: Service d'ORL et chirurgie cervico-faciale, hôpital d'instruction des armées Legouest, 27, avenue de Plantières, BP 90001, 57077 Metz cedex 3, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Barberot
mesh_terms: D000208:Acute Disease; D002114:Calcinosis / Q000150:complications*; D003680:Deglutition Disorders / Q000209:etiology*; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology*; D010614:Pharynx; D013122:Spinal Diseases / Q000150:complications*
keywords: Acute neck pain; Cervical maneuver; Retropharyngeal abscess; Retropharyngeal calcific tendinitis