MR imaging of patients with carotidynia

Abstract

Background and purpose: Carotidynia is an idiopathic neck pain syndrome associated with tenderness to palpation over the carotid bifurcation. Although well known in the otolaryngology and neurology literature, the validity of the entity has recently been questioned, in part because of the almost uniform absence of radiologic or pathologic findings. We report the MR findings in five patients with carotidynia.

Methods: During a period of 44 months, five patients with clinical signs and symptoms consistent with carotidynia were referred for imaging from the otolaryngology service. Each patient underwent MR imaging of the neck on a 1.5-T system. The studies included, as a minimum, pre- and postcontrast axial and postcontrast coronal T1-weighted images. Two patients also had axial T2-weighted imaging and another two patients underwent duplex sonography of the carotids.

Results: All five patients had abnormal enhancing tissue surrounding the symptomatic carotid artery centered at the level of the distal common carotid and carotid bifurcation. This tissue had intermediate signal intensity on T1-weighted images and showed marked enhancement. In all patients, the remaining visualized portions of the carotid artery were normal. Normal flow voids were present throughout the vessel, and the caliber of the vessels was always within normal limits. There was no evidence of intramural hematoma, cervical lymphadenopathy, or atherosclerotic disease of the vessel. In one patient, repeat imaging after resolution of symptoms showed an absence of the previous abnormality.

Conclusion: The MR findings in these patients, along with the lack of any findings to suggest alternative diagnoses, support the existence of carotidynia as a distinct clinical entity.

Fig 1. 48-year-old man with left-sided carotidynia. A, Axial T1-weighted image (700/16/2 [TR/TE/excitations]) at the level of the distal common carotid artery. A skin marker has been placed over the area of swelling and tenderness. Note the abnormal soft-tissue signal surrounding the left carotid (arrow). B, Axial contrast-enhanced T1-weighted image (550/16/2) shows striking enhancement of the tissue surrounding the artery. C, Coronal contrast-enhanced T1-weighted image (550/16/2) shows the enhancement extending to the level of the carotid bifurcation (arrows). A lymph node is seen above the bifurcation (arrowhead). D, Axial contrast-enhanced T1-weighted image (500/12/2) obtained several months later, while the patient remained asymptomatic, shows resolution of the thick rim of enhancement.

Fig 2. 31-year-old woman with right-sided carotidynia. A, Axial T1-weighted image (700/11/2) at the level of the distal common carotid artery shows abnormal soft-tissue signal surrounding the carotid (arrows). The carotid itself is normal in contour and caliber. B, Axial contrast-enhanced T1-weighted image at the same level shows marked enhancement of the tissue surrounding the vessel. Note the smooth margins of the enhancement as it extends toward the internal jugular vein, suggesting conformance to the fascial borders of the carotid sheath.

Fig 3. 51-year-old woman with left-sided carotidynia. A, Axial T1-weighted image (560/15/2) at the level of the distal common carotid artery shows abnormal soft-tissue signal between the carotid and internal jugular vein (arrow). B, Axial contrast-enhanced T1-weighted image (580/15/2) shows marked enhancement of the abnormal tissue. Note again how the smooth margins of the enhancement extend toward the internal jugular vein, in conformance with the expected borders of the carotid sheath.