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Around 20% of the questions are difficult or very difficult and 35% have an optimal level of difficulty for an exam of this type.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Murias Quintana, S.M. Costilla García, J.J. Curbelo García, J. Calvo Blanco, J. Vega Villar, J. Baladrón Romero" "autores" => array:6 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Murias Quintana" ] 1 => array:2 [ "nombre" => "S.M." "apellidos" => "Costilla García" ] 2 => array:2 [ "nombre" => "J.J." "apellidos" => "Curbelo García" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Calvo Blanco" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Vega Villar" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Baladrón Romero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S003383382300125X" "doi" => "10.1016/j.rx.2023.06.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S003383382300125X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510724000958?idApp=UINPBA00004N" "url" => "/21735107/0000006600000005/v1_202410180614/S2173510724000958/v1_202410180614/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173510724000995" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2023.11.009" "estado" => "S300" "fechaPublicacion" => "2024-09-01" "aid" => "1551" "copyright" => "SERAM" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Radiologia. 2024;66:485-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Involvement of supra-aortic trunks in Takayasu arteritis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "485" "paginaFinal" => "486" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Afectación de los troncos supraaórticos en la arteritis de Takayasu" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 864 "Ancho" => 1905 "Tamanyo" => 201226 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imaging findings. Initial echography shows concentric thickening of the proximal segments of the arterial wall of the left CC (white arrows in A). Axial CTA image reveals concentric thickening of the walls of the supra-aortic trunks (blue arrows in B). Axial CTA, 3D volume reconstruction and coronal CTA highlight 50% luminal stenosis in the left CC (yellow circles in C, D and E, respectively). The PET/CT shows a subtle increase in FDG uptake throughout the left CC (yellow circle in F).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CTA: computerised tomography angiography; CC: common carotid; FDG: 18F-Fluorodeoxyglucose; PET/CT: Positron emission tomography.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.D. Choque-Chávez, A. Jareño-Badenas" "autores" => array:2 [ 0 => array:2 [ "nombre" => "F.D." "apellidos" => "Choque-Chávez" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Jareño-Badenas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833823002151" "doi" => "10.1016/j.rx.2023.11.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833823002151?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510724000995?idApp=UINPBA00004N" "url" => "/21735107/0000006600000005/v1_202410180614/S2173510724000995/v1_202410180614/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Calcific tendinitis of the longus colli muscle: From ignorance to misdiagnosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "487" "paginaFinal" => "488" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Durán Lojo, J. Martel Villagrán" "autores" => array:2 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Durán Lojo" "email" => array:1 [ 0 => "silvia.duran.lojo@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Martel Villagrán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tendinitis calcificante del músculo largo del cuello: del desconocimiento al diagnóstico erróneo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 466 "Ancho" => 1874 "Tamanyo" => 139252 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 2. A) Sagittal CT image of the neck after contrast administration: a retropharyngeal collection without peripheral enhancement is observed (red arrow), as well as a small calcification anterior to the odontoid process (yellow arrow). B) Sagittal T2-weighted MR image: the collection with high signal intensity can be seen (red arrow), while the calcification is a very hypointense lesion (yellow arrow). C) Axial T2-weighted MR image: prevertebral calcification (yellow arrow) anterior to the odontoid is identified, which is associated with inflammatory changes in the adjacent tissues (the green arrow indicates oedema of the left longus capitis muscle). D) Plain X-ray of the cervical spine of another female patient: a calcification is observed anterior to the odontoid process, in the same location as in the female patient in case 2.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Calcific tendinitis of the longus colli muscle is a condition caused by the intratendinous deposition of calcium hydroxyapatite, which causes a secondary inflammatory response.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> It is underdiagnosed due to ignorance, and misdiagnoses of more serious conditions are common. With this in mind, the following is a review of its manifestations on imaging and the diagnostic keys that will enable us to avoid unnecessary invasive treatments.</p><p id="par0010" class="elsevierStylePara elsevierViewall">To exemplify this, we present two clinical cases that posed a diagnostic challenge.<span class="elsevierStyleEnunciation" id="enun0005"><span class="elsevierStyleLabel">Case 1</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 61-year-old man with no medical history attended the Accident and Emergency Department with cervical pain with decreased mobility and mild odynophagia. A neck magnetic resonance imaging (MRI) was performed, which revealed bone oedema in the body of the C2 vertebra with intense enhancement after administering gadolinium, associated with prevertebral inflammatory changes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B). In a complementary computerised tomography (CT) study, some small calcifications were observed anterior to C2-C3 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C), not visible in an MRI, and which were already observed on plain X-ray, although with difficulty (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). Based on these findings, the radiological diagnosis was calcific tendinitis of the longus colli muscle. The symptoms were completely resolved following treatment with anti-inflammatories.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span class="elsevierStyleEnunciation" id="enun0010"><span class="elsevierStyleLabel">Case 2</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 54-year-old woman with no notable history attended the Accident and Emergency Department due to cervicalgia, odynophagia and dysphagia for several days. Laboratory tests showed an increase in C-reactive protein. A CT (with and without contrast) and a neck MRI were performed, observing a prevertebral fluid collection and a small calcification located anterior to the odontoid process (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The differential diagnosis included retropharyngeal abscess and calcific tendinitis of the longus colli muscle, the latter of which was considered more likely due to the lack of enhancement of the collection and the finding of prevertebral calcification. The patient was treated with anti-inflammatories, with good progress and resolution of symptoms.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></p><p id="par0025" class="elsevierStylePara elsevierViewall">The clinical manifestations of this condition are nonspecific (pain, stiffness and limitation of neck mobility, as well as odynophagia and dysphagia), and may be associated with an increase in inflammatory markers.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a> Therefore, the diagnosis is purely radiological, based on the pathognomonic finding of amorphous calcifications in the tendon,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> and CT is the most sensitive test. It is accompanied by inflammatory changes in the adjacent soft tissues, which are better visualised with an MRI, frequently forming a retropharyngeal fluid collection, while bone oedema of the adjacent vertebrae is less common.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Although plain X-ray is less sensitive, in some cases these calcifications are also revealed, and an increase in the thickness of the prevertebral tissue can be observed as an indirect sign of inflammatory changes.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The prognosis of this condition is excellent. Symptoms disappear in a few days with non-steroidal anti-inflammatory drugs and physical rest,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> and the calcifications are reabsorbed in one to two weeks<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The main differential diagnosis has to be made with a retropharyngeal abscess, which generally requires surgical drainage. It would also manifest as a retropharyngeal collection, but with a wall and peripheral enhancement, frequently associated with necrotic adenopathy<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Spondylodiscitis is differentiated by the erosion or destruction of the vertebral bodies, with involvement of the intervertebral space.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">It is also important to differentiate between the amorphous calcification typical of this condition and the accessory ossicle of the anterior arch of the atlas, which has a well-defined cortical border.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">It is also worth emphasising the importance of clinical-radiological correlation, since it is possible to find prevertebral calcifications in asymptomatic subjects.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In summary, the following findings are key to making a correct diagnosis: calcification in the fibres of the tendon of the longus colli muscle, retropharyngeal fluid collection without wall or enhancement, absence of necrotic adenopathy and absence of lytic changes in the adjacent vertebrae.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The interest of the cases presented lies in the fact that they show the possible manifestations of this condition and demonstrate the importance of understanding this entity to reduce diagnostic errors, given the therapeutic implications (anti-inflammatory treatment vs surgical drainage in calcific tendinitis and retropharyngeal abscess, respectively).</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">This study received no specific grants from public agencies, the commercial sector or non-profit organisations.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 477 "Ancho" => 1874 "Tamanyo" => 127586 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 1. A) Sagittal MR image, STIR sequence: increased signal in the bone marrow of the body of the C2 vertebra (green arrow) and prevertebral tissue (red arrow), in relation to bone oedema and inflammatory changes, respectively. B) Sagittal T1-weighted MR image with fat saturation after gadolinium administration: intense enhancement of the vertebral body (green arrow) and adjacent soft tissues (red arrow) can be seen. C) Imagen sagital de TC: se objetivan dos pequeñas calcificaciones anteriores a C2 y C3 (flechas amarillas), no visibles en la RM. D) Plain X-ray: a small calcification is identified anterior to the body of the C2 vertebra (yellow arrow).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 466 "Ancho" => 1874 "Tamanyo" => 139252 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 2. A) Sagittal CT image of the neck after contrast administration: a retropharyngeal collection without peripheral enhancement is observed (red arrow), as well as a small calcification anterior to the odontoid process (yellow arrow). B) Sagittal T2-weighted MR image: the collection with high signal intensity can be seen (red arrow), while the calcification is a very hypointense lesion (yellow arrow). C) Axial T2-weighted MR image: prevertebral calcification (yellow arrow) anterior to the odontoid is identified, which is associated with inflammatory changes in the adjacent tissues (the green arrow indicates oedema of the left longus capitis muscle). D) Plain X-ray of the cervical spine of another female patient: a calcification is observed anterior to the odontoid process, in the same location as in the female patient in case 2.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute prevertebral calcific tendinitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Tamm" 1 => "C.C. Jeffery" 2 => "K. Ansari" 3 => "S. 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Hall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1259/bjr/19797697" "Revista" => array:6 [ "tituloSerie" => "Br J Radiol" "fecha" => "2009" "volumen" => "82" "paginaInicial" => "e117" "paginaFinal" => "e121" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19451311" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute retropharyngeal calcific tendinitis: a case report with unusual location of calcification" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.Y. Park" 1 => "W. Jin" 2 => "S.H. Lee" 3 => "J.S. Park" 4 => "D.M. Yang" 5 => "K.N. Ryu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00256-010-0879-3" "Revista" => array:5 [ "tituloSerie" => "Skeletal Radiol" "fecha" => "2010" "volumen" => "39" "paginaInicial" => "817" "paginaFinal" => "820" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735107/0000006600000005/v1_202410180614/S2173510724001009/v1_202410180614/en/main.assets" "Apartado" => array:4 [ "identificador" => "77332" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735107/0000006600000005/v1_202410180614/S2173510724001009/v1_202410180614/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510724001009?idApp=UINPBA00004N" ]
Journal Information
Vol. 66. Issue 5.
Pages 487-488 (September - October 2024)
Vol. 66. Issue 5.
Pages 487-488 (September - October 2024)
Scientific letter
Calcific tendinitis of the longus colli muscle: From ignorance to misdiagnosis
Tendinitis calcificante del músculo largo del cuello: del desconocimiento al diagnóstico erróneo
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