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OBJECTIVES: Idiopathic carotidynia is a syndrome characterized by pain and tenderness over the carotid artery without an associated structural luminal abnormality. Controversy exists over whether this is a distinct clinical entity or merely a symptom attributable to other causes of neck pain, such as carotid dissection or vasculitis. We present a rare case of carotidynia.
METHODS: A previously healthy 50-year old female presented with acute onset severe right neck pain of five days duration, associated with tenderness and headaches. On physical examination, 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 ultrasonography, which was initially interpreted as a thrombosed dissection versus intramural hematoma of the common carotid artery (CCA) bulb and proximal internal carotid artery (ICA) (Figure). 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 imaging (MRI) and computed tomography (CT) demonstrated transmural inflammation of the right CCA and ICA, without luminal narrowing or a dissection flap. The patient was diagnosed with idiopathic carotidynia, based on the radiographic findings and clinical presentation. Treatment with NSAIDs and aspirin was initiated.
RESULTS: The patient’s pain was significantly improved within two days of starting low dose aspirin therapy and NSAIDS. Repeat duplex performed three days later revealed a 50% decrease in arterial wall thickness at the carotid bulb (Figure). At three-month follow-up, her carotid artery appeared normal on duplex ultrasonography.
CONCLUSION: We describe a rare case of carotidynia, initially mistaken for a carotid artery dissection/intramural hematoma. Idiopathic carotidynia represents a distinct pathological entity with characteristic radiological findings, including perivascular inflammation, normal blood flow and luminal integrity, that has a self-limiting course and responds well to supportive medical management and treatment with NSAIDS. Clinicians should consider idiopathic carotidynia as a diagnosis in cases of spontaneous neck pain, tenderness, and headaches.