Longus colli tendinitis (LCT) has been described in several case reports, and is likely underdiagnosed due to its non-specific symptoms and self-limiting nature. It usually presents as acute neck pain with retropharyngeal swelling seen on nasoendoscopy and imaging studies. This may lead to unnecessary invasive interventions if physicians are unaware of the disease course. 

We discuss a case of LCT in a young woman who was treated at our institution, with recommendations on how to identify and treat such cases accurately without over-treatment.

Contrast-enhanced computerized tomography (CT) neck confirmed intra-tendinous calcific depositions anterior to C2–C5 and retropharyngeal fluid with no discernible rim enhancement. A diagnosis of longus colli tendinitis was made and she improved with conservative treatment with analgesia and rest.

LCT is self-limiting in nature, with all reported cases resolving spontaneously with neck immobilization and NSAIDs. Some patients with severe symptoms obtain relief from a short course of steroid therapy. LCT should be considered if patients present with severe acute neck pain with characteristic radiological findings, to prevent unnecessary invasive procedures and delayed discharges.