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Prevertebral tendinitis: how to avoid unnecessary surgical interventions.
Georg Philipp Hammer1, Robert Vollmann, Peter Valentin Tomazic
1ENT University Hospital Graz, Medical University of Graz, Graz, Austria. georg.hammer@medunigraz.at
The Laryngoscope
|May 3, 2012
Summary
Prevertebral tendinitis presents with neck pain and stiffness but has lower inflammation markers than deep cervical abscess. Magnetic resonance imaging with diffusion-weighted images is key for diagnosing this condition.
Area of Science:
- Radiology
- Inflammatory Diseases
- Musculoskeletal Disorders
Background:
- Prevertebral tendinitis, an inflammatory condition of cervicothoracic muscles, can mimic deep cervical abscess on computed tomography (CT).
- Accurate differentiation is crucial as treatment strategies differ significantly between these two pathologies.
Purpose of the Study:
- To compare clinical, laboratory, and imaging findings in prevertebral tendinitis versus deep cervical abscess.
- To identify diagnostic markers for distinguishing prevertebral tendinitis from deep cervical abscess.
Main Methods:
- A case series of 10 patients with prevertebral tendinitis was compared to 65 patients with deep cervical abscess.
- Contrast-enhanced CT was used for initial imaging; MRI with diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping was performed for prevertebral tendinitis detection.
Main Results:
- Prevertebral tendinitis patients reported neck pain, globus sensation, and stiffness with mild C-reactive protein elevation and normal white blood cell counts.
- CT revealed amorphous calcifications in prevertebral tendinitis, while DWI showed benign prevertebral effusion.
- Inflammatory markers (CRP, WBC) were significantly lower in prevertebral tendinitis compared to deep cervical abscess (P < .05).
Conclusions:
- Prevertebral tendinitis should be suspected in patients with neck pain, stiffness, and globus sensation, especially with minimal laboratory signs of inflammation.
- Magnetic resonance imaging (MRI) with diffusion-weighted images and ADC map is the definitive imaging modality for diagnosing prevertebral tendinitis.
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