1. Ultrasound contribution in the diagnosis of idiopathic carotidynia
19th Meeting of European Society of Neurosonology and Cerebral Hemodynamics Roma, Italy
Ultrasound contribution in the diagnosis of idiopathic carotidynia
J.García-García, JM.Ceballos Ortiz, MT.Sanjuan-Pérez, O. Ayo-Martín, T.Segura .
Servicio de Neurología, Complejo Hospitalario Universitario de Albacete; SPAIN.
BACKGROUND & OBJECTIVE
METHODS / CASE REPORT
Carotidynia (local pain reproducible with light pressure on the carotid artery) is a controversial and poorly understood vascular condition. Even though it was removed as a pathological entity from the second International Headache Society classification in 2004, recent reports confirm that there are structural abnormalities and characteristic radiological findings in patients with carotidynia.
We report a case of carotidynia showing the typical ultrasonographic findings described in these patients.
A 50 year old woman presented with a painful, pulsating nodosity on the right side of her neck, which appeared few days earlier without any previous trauma. The pain was constant, of moderate to severe intensity and fluctuated from a dull pressure to throbbing exacerbations. Swallowing and coughing were difficult and painful. Neurological exploration was otherwise normal. The combination of symptoms, clinical course and findings (show results of MRI and ultrasound scanning) indicated a diagnosis of carotydinia. Antiinflammatories was prescribed to treat pain and provided rapid relief.
Fay first described an atypical pain of the neck combined with sensitivity of the carotid artery to pressure in 1927 as carotidynia
RESULTS
Doppler sonography revealed a hypoechoic thickening of the distal right common carotid artery (CCA) wall within the region of tenderness. The change in the wall bulged slightly in the lumen but did not cause any significant acceleration of the blood flow. The ultrasound thickening affected the whole wall of the artery (Figure 1).
Appropriate investigations (CTA and MRI scan) did not show any evidence of structural abnormalities suggestive of disection or arteritis. However gadolinium-enhanced MR imaging showed contrast enhancement of the distal symptomatic CCA (Figure 2).
FIGURE 1
Follow-up examinations Figure 3. Sonographic serial follow-up imaging showed that wall broadening halved after 35 days A B
FIGURE 2
Transversal section MRI. A. T2 weighted image showing edematous wall thickening of the right distal CCA (see red arrow). B. T1 Post contrast enhancement scan indicates contrast enhancing tissue (arrow) surrounding the right distal CCA
FIGURE 3
We mainly emphasize the focal eccentric thickening of the carotid wall at the level of the pain referred by the patient, without any hemodynamic changes at the Doppler study or changes of the vascular lumen at MRI. Furthermore, MRI allows the depiction of other changes of the vessel wall, as well as other differential diagnoses, particularly arterial dissection, which was excluded because the absence of intramural hematoma (hyperintense crescent within vessel wall on fat-saturated T1 ,Figure 2C) and intimal flap. C
CONCLUSIONS
The presence of focal thickening in the carotid wall, generally without haemodynamic changes, is a typical pattern found in ultrasound studies in patients suffering from idiopathic carotidynia.
The findings of this case report are similar to those previously described in carotidynia, which further supports the classification of carotidynia as a distinct nosological entity.
Stanbro M, Gray BH, Kellicut DC. Carotidynia: revisiting an unfamiliar entity. Ann Vasc Surg. 2011;25:1144–53.