Role of Ultrasound in the Diagnosis and Follow-Up of Transient Perivascular Inflammation of the Carotid Artery (TIPIC) Syndrome: a Case Report

Abstract

Idiopathic carotidynia (IC) is a rare, possibly under-diagnosed clinico-radiologic entity that consists of acute unilateral neck pain and tenderness over the carotid bifurcation. Lecler et al. have recently described this condition associated with characteristic imaging features of transient perivascular soft tissue inflammation at the level of the affected carotid bifurcation, by a new term TIPIC (transient perivascular inflammation of the carotid artery) syndrome. We report the case of an Indian man, with recurrent right-sided TIPIC syndrome and past history of transient left-sided symptoms. On initial presentation, the clinical history, ultrasound (US) features, magnetic resonance imaging (MRI) findings, and laboratory investigations of the patient were correlated to establish the diagnosis of TIPIC syndrome. Doppler US was performed for imaging follow-up of this patient, when he presented again with recurrence of similar symptoms of right neck pain. In this 45-year-old patient, US demonstrated a characteristic perivascular echogenic soft tissue around the symptomatic carotid artery. MRI confirmed these imaging findings and ruled out carotid dissection. Patient responded to antiinflammatory medications. Recurrence and resolution of the soft tissue thickening surrounding the affected carotid arteries were documented on serial follow-up US examinations. This case report illustrates that US can be effectively used in the diagnosis as well as follow-up of TIPIC syndrome.

Transient Perivascular Inflammation of the Carotid Artery (TIPIC) Syndrome: Does Ultrasound Decipher the Myth?

“…However, it has been an inconsistent finding across the literature. The role of US in follow-up of patients with TIPIC syndrome has been documented by the above mentioned authors [1,6,7,9].…”

“…Takamura et al have reported a rare recurrent case of TIPIC syndrome with a temporary carotid plaque in a young male[6]. I have encountered and reported a case of recurrent unilateral TIPIC syndrome with a past history of transient symptoms on the contralateral side of the neck[9]. Imaging techniques such as ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT) imaging, CT angiography (CTA), and [18F] fluoro-deoxy-glucose positron-emission tomography-CT have been employed for establishing the diagnosis of this benign, self-limiting condition[1,10].In 2005, Arning reported a consistently similar ultrasound pattern of hypoechoic perivascular soft tissue thickening along the carotid bulb, exactly in the region of tenderness along with slight narrowing of the affected vessel lumen; in six patients suspected of carotidynia[11].…”