Clinical caseComparative evolution of carotidynia on ultrasound and magnetic resonance imagingÉvolution comparée d’une carotidynie à l’écho-doppler et l’imagerie par résonance magnétique
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:
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an antiphospholipid syndrome with arterial and deep venous adverse clinical expressions secondary to a systemic lupus erythematous under anticoagulant treatment;
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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.
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