Images of the month 3: Transient perivascular inflammation of the carotid artery syndrome

摘要

A 44-year-old man presented to the emergency department with a painful, palpable mass in the area of the right carotid triangle lasting for 1 week. He was otherwise healthy without any trauma or further otorhinolaryngological symptoms. Other than a pain at the right carotid triangle on pressure, physical and otorhinolaryngological examinations were unremarkable. Ultrasonography of the neck revealed a hypoechogenic mass in the adventitial layer of the right medial common carotid artery with a crescent shape in transverse view (Fig 1a) reaching from the distal common carotid artery to the carotid bulb (35 × 12 × 6 mm; Fig 1b). Carotid intima-media thickness was normal and no dissection membrane could be found. Subsequent ultrasonography of the aorta, its major branches and temporal arteries was also unremarkable, while magnetic resonance imaging of the carotid arteries revealed local contrast enhancement of the right common carotid artery (Fig 2). No potential signs or symptoms for inflammation, especially vasculitis, were found and comprehensive laboratory testing including inflammatory parameters, thyroid hormones, autoantibodies and immunoglobulin G4 was unremarkable. 18-fluorodeoxyglucose positron emission tomography – computed tomography showed only an increased tracer uptake of the right common carotid artery. Diagnosis of transient perivascular inflammation of the carotid artery (TIPIC) syndrome was made and dexibuprofen 400 mg twice daily together with pantoprazole 40 mg once daily peroral were prescribed for 2 weeks. The pain resolved within a few days and the hypoechogenic mass was undetectable in a followup visit 2 weeks later. Since the patient's initial presentation, he was still asymptomatic 1 year later.