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Carotidynia

Sparrow Health System Lansing, Michigan 48912
Michigan State University East Lansing, Michigan 48824

A 49-year-old man presented with acute pain and swelling in the left side of the neck. The patient was afebrile, and his laboratory tests had normal values. He was immunosuppressed as a result of acute lymphocytic leukemia and concurrent chemotherapy; therefore, CT was performed to evaluate for occult infection or tumor. He underwent an MR examination later the same day. The preliminary diagnosis of carotidynia was established. The patient was treated symptomatically and improved over the next few weeks. Follow-up imaging was not performed.

Carotidynia is a controversial diagnosis, which is based upon clinical grounds. The International Headache Society Classification Committee criteria for the diagnosis of idiopathic carotidynia requires at least one of the following overlying the carotid artery: tenderness, swelling, or increased pulsation. It also deems that appropriate investigations not reveal any structural abnormality and that it be a self-limiting syndrome of less than 2 weeks' duration [1]. The differential diagnosis for carotidynia includes giant cell arteritis, arteriosclerosis, thrombosis, fibromuscular dysplasia, dissection, aneurysm, lymphadenitis, submandibular gland disease, and neck neoplasm. The existence of the diagnosis itself is debated, and some researchers believe it is not a valid entity, yet an inflammatory etiology is supported by the usual response to therapy with nonsteroidal antiinflammatory drugs or with corticosteroids [2, 3].

The appearance of carotidynia on MR images has been described, but not its appearance on CT. Enhancing tissue is seen in the carotid sheath on T1-weighted MR images (Fig. 3A), and increased intensity in this same region is seen on T2-weighted images (Fig. 3B). No associated narrowing or irregularity of the vessel lumen is present (Fig. 3C). In this case, the CT findings are analogous, with symmetric homogeneous soft-tissue infiltration of the carotid-sheath (Fig. 3D).

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A. —49-year-old man with acute pain and swelling in left side of neck. Fat-suppressed T1-weighted MR image shows homogeneous enhancement of abnormal soft tissue (arrow) infiltrating left carotid sheath.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B. —49-year-old man with acute pain and swelling in left side of neck. Axial T2-weighted MR image corresponding to A shows increased signal intensity in same region (arrow).

View larger version (66K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C. —49-year-old man with acute pain and swelling in left side of neck. MR angiogram shows no significant narrowing of carotid lumen.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D. —49-year-old man with acute pain and swelling in left side of neck. CT scan obtained same day as MR images (A-C) shows symmetric homogeneous soft-tissue (arrow) infiltration of carotid sheath with normal-appearing lumen.

No known pathologic confirmation of carotidynia exists; it therefore remains a diagnosis of exclusion [1]. Because the presented images and clinical presentation were most consistent with this diagnosis, further intervention was appropriately deferred for this patient.

References

1. Burton BS, Syms MJ, Petermann GW, Burgess LPA. MR imaging of patients with carotidynia. AJNR 2000;21:766 -769[Abstract/Free Full Text]
2. Biousse V, Bousser M. The myth of carotidynia. Neurology 1994;44:993 -995[Free Full Text]
3. Hill LM, Hastings G. Carotidynia: a pain syndrome. J Fam Pract 1994;39:71 -75[Medline]

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Buetow, M. P. Articles by Delano, M. C. Search for Related Content PubMed PubMed Citation Articles by Buetow, M. P. Articles by Delano, M. C. Social Bookmarking                      What's this?