Back to Karmody Posters

INTRODUCTION: We report the unusual case of carotidynia initially diagnosed as a carotid dissection. A 50-year old healthy female presented with acute onset of severe right neck pain of five days duration, associated with tenderness and headache. On physical exam, the patient was neurologically intact with focal tenderness over her right carotid triangle. There were no systemic signs or symptoms of infection. The patient underwent carotid duplex ultrasound, which demonstrated a thrombosed dissection versus intramural hematoma visualized at the common carotid artery (CCA) bulb and proximal internal carotid artery (ICA). In the setting of adenomyosis and heavy menstrual bleeding, additional imaging was obtained to confirm the diagnosis of dissection prior to initiating anticoagulation. T1 weighted magnetic resonance and computed tomography imaging suggested abnormal asymmetric soft tissue surrounding the right CCA and ICA without luminal narrowing or a dissection flap.
METHODS: Based on the composite results of multiple imaging modalities, the patient was diagnosed with carotidynia, specifically idiopathic inflammatory pseudotumor of the carotid sheath. Treatment with NSAIDs was initiated.
RESULTS: The patient’s pain was significantly improved within 2 days of NSAID therapy. Repeat duplex performed 3 days later showed 50% decrease in wall thickness near the carotid bulb(Figure 1).
CONCLUSION: We herein describe a rare case of carotidynia, initially mistaken for a carotid artery dissection. Clinicians should consider idiopathic inflammatory pseudotumor of the carotid sheath as a diagnosis in cases of spontaneous neck pain and tenderness, and headaches.