Type:
Educational Exhibit
Keywords:
Musculoskeletal soft tissue, CT, Other, Education and training
Authors:
W. Roughan, S. Do, A. Callinan
DOI:
10.26044/ranzcr2023/C-134
Background
Calcific tendinitis occurs due to calcium hydroxyapatite crystal deposition in peri-articular muscle attachments [1]. The condition can affect any joint [1]. Case reports describing calcific tendinitis in locations such as the iliopsoas muscle [2], second digit flexor tendon sheath [3] and rectus femoris have all been published [4]. However, to our knowledge, this is the first documented case of calcific tendinitis affecting the middle scalene muscle.
The closest muscle anatomically to the middle scalene reported in the literature to be affected by calcific tendinitis is the longus colli muscle. Acute calcific tendinitis of the longus colli, or acute calcific prevertebral tendinitis, is a rare inflammatory condition that causes severe neck pain, neck stiffness and odynophagia [5]. The condition is often misdiagnosed due to the nonspecific nature of the presentation, which can result in unnecessary interventions [6]. CT scan of the neck is the modality of choice for diagnosing calcific tendinitis of the longus colli, as CT allows for detection of both prevertebral oedema and calcium hydroxyapatite crystals [7]. Calcific deposits are difficult to detect on magnetic resonance imaging and plain radiography is less sensitive at diagnosing calcific tendinitis [7]. Calcific tendinitis of the longus colli muscle is a self-limiting condition that can be managed conservatively with non-steroidal anti-inflammatory drugs (NSAIDs) and immobilisation in a soft collar [7].
Herein we describe a unique case of calcific tendinitis, presenting similarly to acute calcific tendinitis of the longus colli. Awareness of the radiological appearance of calcific tendinitis of the middle scalene muscle is crucial to avoid misdiagnosis and unnecessary interventions.