"TransIent perivascular inflammation of the carotid artery (TIPIC) syndrome" as a rare case of laterocervical pain: Multimodal diagnosis

Abstract

''TransIent Perivascular Inflammation of the Carotid artery (TIPIC) syndrome" is an unusual cause of unilateral neck pain, due to a nonspecific inflammation of the carotid artery. This entity has been for long known as "carotidynia" and described as a syndrome rather than a distinct pathologic entity. Recently, the presence of structural abnormalities of the carotid artery wall has been demonstrated, leading to the introduction of radiological criteria which, in the appropriate clinical context, allow to diagnose TIPIC syndrome. TIPIC syndrome is a rather rare disease and, since its first description by Fay in 1927, only a small series of patients have been published. The interest of our case lies in the fact that diagnosis and follow-up were assessed on ultrasound and magnetic resonance imaging, demonstrating that a correlation between clinical evolution and radiological findings does exist. In addition, DWI sequence was performed at the time of diagnosis and at resolution. To our knowledge, such an assessment has never been reported in the previous literature.

Keywords: Carotidynia; Fay syndrome; Neck pain; TIPIC syndrome.

Fig. 1

Doppler ultrasound (A) shows an eccentric and laterally developed hypoechoic adventitial thickening of the right internal carotid. Intimal plaque and stenosis are absent. Regression of the hypoechoic thickening is found after 3 wk of treatment with non-steroidal anti-inflammatory drugs (B).

Fig. 2

(A, B, C and D) axial STIR, axial Ultrafast spoiled GE, DWI and coronal postcontrast images at the level of the right carotid artery show an abnormal soft tissue signal surrounding the carotid artery.

Fig. 3

(A, B, C and D) axial STIR, axial Ultrafast spoiled GE, DWI and coronal postcontrast images at the same level of Fig. 2, obtained 3 wk later, when the patient had become asymptomatic, show resolution of the abnormal soft tissue signal.