Presentation
2 days of acute right anterior neck pain and tenderness.
Patient Data
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Soft-tissue density surrounds the distal portion of the right common carotid artery particularly anterolaterally. No obvious change in caliber of the artery itself on these non-angiographic images. Small volume calcified atheroscelrotic plaque at the carotid bifurcation bilaterally. No lymphadenopathy. Incidental 2cm hypodense left thyroid nodule.
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Soft-tissue density surrounds the distal portion of the right common carotid artery particularly anterolaterally. There is only a very subtle flattening of the contour of the artery at this site without stenosis. No intimal flap or thrombosis seen.
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T1 hypointense/T2 hyperintense region at the anterior aspect of the right carotid sheath with post-contrast enhancement, corresponding to the abnormal tissue seen on CT. This extends over a short length of around 3.5 cm. No associated diffusion restriction.
Subtle crescentic T2 hyperintensity in the anterior wall of the right common carotid artery in this region. Subtle thickening and hyperenhancement of the wall of the right common carotid artery compared to the left.
T2 hyperintense thyroid nodule in the inferior pole of the left thyroid lobe.
Case Discussion
Perivascular abnormality in the right carotid space, directly related to the right common carotid artery, characterized by T2 hyperintensity and enhancement with only minor luminal narrowing and no intimal flap. The appearances and clinical presentation suggest carotidynia/transient perivascular inflammation of the carotid artery (TIPIC) syndrome. Carotid dissection is considered less likely given the degree of surrounding enhancement and perivascular predominance of the abnormality.