Neck pain on right, for 1 week. No neurological deficit. No history of trauma
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T2 hyperintense soft tissue thickening posterior to the right carotid bulb, which shows moderate post gadolinium enhancement on T1W fat saturated images
Carotidynia is a syndrome characterised by unilateral neck pain and focal tenderness, usually at, but not always to, the limited to the site of carotid bifurcation. The aetiology of this syndrome is unknown.
Diagnosis can be made clinically, and should be established after ruling out other more serious causes of carotid wall thickening, including large vessel vasculitides.
MRI findings typically include ill-defined soft tissue thickening within the carotid sheath, usually at the carotid bifurcation. The soft tissue displays hyperintense signal on T2 and T2FS sequences. On T1FS sequences, it appears iso-intense, as opposed to the hyperintensity of intramural haematoma of dissection. On post gadolinium T1FS sequence, the thickened soft tissue shows moderate to intense enhancement, again a point which is helpful in differentiating this entity from dissection. The lesion does not cause any significant narrowing of the carotid lumen.
The pain usually responds to NSAIDS or steroids.
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