Clinical case
Comparative evolution of carotidynia on ultrasound and magnetic resonance imagingÉvolution comparée d’une carotidynie à l’écho-doppler et l’imagerie par résonance magnétique

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Summary

Carotidynia is rare and associates neck pain with tenderness to palpation usually over the carotid bifurcation, the diagnosis of which is based on magnetic resonance imaging (MRI). Ultrasounds (US) are also frequently used but their accuracy in predicting the course of the disease is unknown. We are reporting the case of a 52-year-old man who presented a typical carotidynia. Clinical symptoms, ultrasound and MRI imaging evolution were closely correlated. Our case suggest that after a first MRI to set a positive diagnosis of carotidynia and exclude differential diagnoses, US which is more widely available and less expensive could constitute the imaging of reference for the follow-up.

Résumé

La carotidynie est une pathologie rare qui se caractérise par une douleur cervicale généralement en regard d’une bifurcation carotidienne, exacerbée par la palpation et dont le diagnostic est posé par imagerie par résonance magnétique. L’échographie doppler est fréquemment utilisée mais ses performances pour le suivi de la carotidynie sont mal connues. Nous rapportons le cas d’un homme de 52 ans qui a présenté un cas typique de carotidynie. Les signes cliniques et les données échographiques et d’IRM initiaux et au cours du suivi étaient bien corrélés. Notre cas suggère qu’après une première IRM qui établit le diagnostic positif et élimine les diagnostics différentiels, l’échographie (plus accessible et moins coûteuse) pourrait constituer l’imagerie de référence pour le suivi.

Introduction

According to the International Headache Classification, carotidynia is a type of neck pain associated with tenderness to palpation over the carotid bifurcation; it usually lasts around less than two weeks [1], [2]. Though its prevalence is considered to be low, no precise epidemiological data is available. Indeed, since its first description by Fay in 1927, only a small series of patients have been published [3]. In addition, it is currently under debate whether it is a true independent clinical entity or a syndrome encompassing many varieties of cervical pain. Even though, carotidynia's discovery is often stressful for the patient, it is commonly admitted that its clinical course is benign and its risk of recurrence after appropriate treatment was reported to be low in small available series. Its long-term prognosis, particularly regarding risk of recurrence is, however, unknown [4]. Therefore, establishing a positive diagnosis appears to be the most important step in carotidynia's management. For that purpose, imaging can bring crucial information by making a positive diagnosis and eliminating other vascular and non-vascular etiologies. Indeed, suggestive radiological abnormalities of the carotid bifurcation zone, evidencing an inflammatory process, were reported recently particularly on ultrasound (US) and magnetic resonance imaging (MRI) [5], [6]. As compared with US, MRI can more accurately rule out differential diagnoses (arterial dissection, hematoma…) than US [7], but is more expensive and less easily available. The aim of the present case report is to assess the evolution of a typical carotidynia case on US and MRI.

Section snippets

Case description

We are reporting the case of a 52-year-old man who was examined in the vascular medicine unit of the department of internal medicine of Montpellier university hospital for a unilateral left laterocervical pain triggered by palpations with temporal irradiation evolving during two days. The patient's main medical history includes:

  • an antiphospholipid syndrome with arterial and deep venous adverse clinical expressions secondary to a systemic lupus erythematous under anticoagulant treatment;

  • a B cell

Discussion

The case we reported represents a typical case of a carotidynia whether in terms of clinical symptoms, radiological findings and benign course [4].

Its main interest lies in the fact that diagnosis and follow-ups were assessed simultaneously on duplex US and MRI with confirmation of the full regression of inflammation on PET-CT. To our knowledge, such an assessment has never been reported before. In a recent case report, Schaumberg reported that duplex US and MRI provided similar information

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

References (9)

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