Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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May 26, 2022
Carotidynia or Transient Perivascular Inflammation of the Carotid Artery (TIPIC) Syndrome
- Background:
- Carotidynia or transient perivascular inflammation of the carotid artery (TIPIC) syndrome is a rare disorder presenting with unilateral neck pain.
- It is an idiopathic and self-limited clinical entity with a prevalence of 2.8% in patients presenting with acute neck pain. Symptoms resolve in about 2 weeks.
- Patients may recur within the first 6 months.
- Clinical Presentation:
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Continuous and throbbing pain in the lateral neck region and tenderness over the carotid artery; symptoms worsen with head movements.
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May be associated with neurologic symptoms
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In 10% of cases, it presents bilaterally.
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- Key Diagnostic Features:
- Eccentric thickening of the carotid artery wall, abnormal soft tissue surrounding without luminal narrowing
- CT shows enhancement with eccentric perivascular infiltration surrounding the carotid artery.
- MRI shows T1-hypointense and T2-hyperintense perivascular infiltration at the carotid artery, enhanced after gadolinium injection.
- Differential Diagnoses:
- Large-vessel vasculitis: Irregular pattern, alternating areas of stenosis and dilatation
- Arterial dissection: Narrowed eccentric lumen surrounded by a crescent-shaped mural thrombus and thin annular enhancement
- Jugular vein thrombosis: CT shows venous distension with enhancement in the walls, with intraluminal hypodensity and inflammation of the surrounding soft tissues.
- Head and neck tumors: Intra- or extra-axial mass
- Thyroiditis: On an acute inflammatory stage, a CT can demonstrate edema and abscess formation.
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Treatment:
- Self-limiting condition in which symptoms spontaneously resolve within 2 weeks
- Supportive treatment includes nonsteroidal anti-inflammatory drugs and corticosteroids.
