Acute calcific longus colli tendinitis, also known as retropharyngeal or acute calcific prevertebral tendinitis, is a reactive self-limiting inflammatory response to acute or subacute deposition of amorphous calcium hydroxyapatite crystals in the tendons of the longus colli muscle, anterior to the C1-C2 disc space.

The patient’s presentation could be easily misdiagnosed as a retropharyngeal abscess. However, the presence of subtle findings on CT would lead to the correct diagnosis. The management of this condition is mainly with non-steroidal anti-inflammatory drugs (NSAIDs). Monitoring of upper airway obstruction is important as large reactive prevertebral collections may indirectly compress the airway.

This patient recovered well with a course of oral NSAIDs.