{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T11:25:20Z","timestamp":1758799520015,"version":"3.44.0"},"reference-count":21,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,9,10]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:p>A middle-aged woman was referred to the admitting medical team with sudden onset pain at the base of the skull. Initial differentials included subarachnoid haemorrhage and meningitis. Due to the referral of a patient presenting with occipital headache, there was a confirmation bias by the medical team in the initial assessment of this patient, and alternative diagnoses were not considered in the first instance. On review by a medical consultant, pathology in the upper neck was proposed as a cause for the pain. Dedicated CT imaging of the neck revealed acute calcification of the longus colli muscle. This is a usually benign self-limiting condition which is managed in the first instance with non-steroidal anti-inflammatory drugs. Acute calcification of the longus colli is a rare and poorly recognised condition. It should be considered as a potential differential for patients presenting with neck pain, particularly in the presence of odynophagia and mildly elevated inflammatory markers. Cognitive bias should be considered during initial assessment of patients to help reduce premature closure when forming differential diagnoses.<\/jats:p>","DOI":"10.1136\/bcr-2025-267111","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T10:30:18Z","timestamp":1758796218000},"page":"e267111","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Confirmation bias in medical referrals: an unusual presentation of pain at the base of the skull"],"prefix":"10.1136","volume":"18","author":[{"given":"Katie","family":"Prior","sequence":"first","affiliation":[{"name":"Acute Medicine, London North West University Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying Kristen","family":"Lau","sequence":"additional","affiliation":[{"name":"Acute Medicine, London North West University Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Harris","sequence":"additional","affiliation":[{"name":"Acute Medicine, London North West University Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mostafa","family":"Ellatif","sequence":"additional","affiliation":[{"name":"London North West Healthcare NHS Trust, Harrow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"2025092503300885000_18.9.e267111.1","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1515\/dx-2022-0120","article-title":"Cognitive biases in internal medicine: a scoping review","volume":"10","author":"Loncharich","year":"2023","journal-title":"Diagnosis (Berl)"},{"key":"2025092503300885000_18.9.e267111.2","doi-asserted-by":"crossref","unstructured":"Prakash S , Bihari S , Need P , et al . Immersive high fidelity simulation of critically ill patients to study cognitive errors: a pilot study. BMC Med Educ 2017;17. doi:10.1186\/s12909-017-0871-x","DOI":"10.1186\/s12909-017-0871-x"},{"key":"2025092503300885000_18.9.e267111.3","doi-asserted-by":"crossref","first-page":"43","DOI":"10.31083\/j.jin2302043","article-title":"Headache Disorders: Differentiating Primary and Secondary Etiologies","volume":"23","author":"Hernandez","year":"2024","journal-title":"J Integr Neurosci"},{"key":"2025092503300885000_18.9.e267111.4","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.j3221","article-title":"Advances in the diagnosis and management of neck pain","volume":"358","author":"Cohen","year":"2017","journal-title":"BMJ"},{"key":"2025092503300885000_18.9.e267111.5","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/j.jaad.2019.06.1286","article-title":"Confirmation bias in medical decision-making","volume":"82","author":"Elston","year":"2020","journal-title":"J Am Acad Dermatol"},{"key":"2025092503300885000_18.9.e267111.6","doi-asserted-by":"publisher","DOI":"10.4997\/JRCPE.2018.306"},{"key":"2025092503300885000_18.9.e267111.7","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2013-001987"},{"key":"2025092503300885000_18.9.e267111.8","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2005.073221"},{"key":"2025092503300885000_18.9.e267111.9","doi-asserted-by":"crossref","unstructured":"Maselli F , Storari L , Mourad F , et al . Headache, Loss of Smell, and Visual Disturbances: Symptoms of SARS-CoV-2 Infection? A Case Report. Phys Ther 2023;103. doi:10.1093\/ptj\/pzad017","DOI":"10.1093\/ptj\/pzad017"},{"key":"2025092503300885000_18.9.e267111.10","doi-asserted-by":"publisher","DOI":"10.1080\/10669817.2021.1937813"},{"key":"2025092503300885000_18.9.e267111.11","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.neurad.2019.04.006","article-title":"Imaging Features of isolated hypoglossal nerve palsy","volume":"47","author":"Guarnizo","year":"2020","journal-title":"J Neuroradiol"},{"key":"2025092503300885000_18.9.e267111.12","doi-asserted-by":"crossref","first-page":"105","DOI":"10.33393\/aop.2024.3245","article-title":"Red flags for potential serious pathologies in people with neck pain: a systematic review of clinical practice guidelines","volume":"14","author":"Feller","year":"2024","journal-title":"Arch Physiother"},{"key":"2025092503300885000_18.9.e267111.13","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1007\/s10140-017-1537-z","article-title":"Frequency of acute longus colli tendinitis on CT examinations","volume":"24","author":"Boardman","year":"2017","journal-title":"Emerg Radiol"},{"key":"2025092503300885000_18.9.e267111.14","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1016\/j.radcr.2024.11.085","article-title":"Not your common neck pain: Longus coli tendonitis","volume":"20","author":"Colantonio","year":"2025","journal-title":"Radiol Case Rep"},{"key":"2025092503300885000_18.9.e267111.15","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1016\/j.radcr.2022.01.023","article-title":"Calcific tendinitis of the longus colli: An uncommon cause of neck pain","volume":"17","author":"Guerroum","year":"2022","journal-title":"Radiol Case Rep"},{"key":"2025092503300885000_18.9.e267111.16","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1051\/sicotj\/2017032","article-title":"Longus colli tendinitis. A review of literature and case series","volume":"3","author":"Shawky","year":"2017","journal-title":"SICOT J"},{"key":"2025092503300885000_18.9.e267111.17","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.2106\/00004623-199411000-00006","article-title":"Acute calcific retropharyngeal tendinitis. Clinical presentation and pathological characterization","volume":"76","author":"Ring","year":"1994","journal-title":"J Bone Joint Surg Am"},{"key":"2025092503300885000_18.9.e267111.18","doi-asserted-by":"crossref","first-page":"S434","DOI":"10.1007\/s00586-012-2584-5","article-title":"Acute calcific tendinitis of the longus colli muscle: case report and review of the literature","volume":"22 Suppl 3","author":"Zibis","year":"2013","journal-title":"Eur Spine J"},{"key":"2025092503300885000_18.9.e267111.19","doi-asserted-by":"publisher","DOI":"10.4184\/asj.2014.8.5.675"},{"key":"2025092503300885000_18.9.e267111.20","first-page":"98","article-title":"Acute Calcific Tendonitis of the Longus Colli","volume":"18","author":"Raggio","year":"2018","journal-title":"Ochsner J"},{"key":"2025092503300885000_18.9.e267111.21","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/19797697"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-267111","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T10:30:23Z","timestamp":1758796223000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-267111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":21,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,25]]},"published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1136\/bcr-2025-267111"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-267111","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]}}}