Carotidynia in the elderly

Transient perivascular inflammation of the carotid artery; a rare cause of intense neck pain

Carotidynia or Transient Perivascular Inflammation of the Carotid Artery (TIPIC) syndrome is a rare cause of atypical neck pain. Exact aetiopathogenesis of this clinical entity is poorly understood. A 43-year-old female presented with progressively increasing right side neck pain of 3 days duration associated with focal tenderness over the right carotid pulse corresponding to the level of upper border of thyroid cartilage. Her inflammatory markers were not elevated. An ultrasound scan revealed increased echogenicity surrounding the distal common carotid artery, obliteration of the perivascular tissue planes with preserved doppler flow pattern. MRI showed soft tissue thickening around the distal common carotid artery, carotid bulb and proximal external carotid artery on right side of the neck corresponding to sonographic findings with gadolinium enhancement. A diagnosis of TIPIC syndrome was made and she was started on celecoxib. Pain completely subsided within 2 weeks. In conclusion, TIPIC syndrome is a rare differential diagnosis of neck pain. It is caused by a transient perivascular inflammation of the carotid artery. A high degree of suspicion is necessary for the diagnosis. Imaging is the gold standard investigation for the diagnosis of TIPIC syndrome. It is a self-limiting pathology and often responds rapidly to nonsteroidal anti-inflammatory drugs.

Carotidynia: an unusual pain in the neck

Described by Fay in 1927, carotidynia has not received much attention in the otolaryngology-head and neck surgery literature. This unusual entity is characterized by ipsilateral neck pain in the region of the carotid artery near its bifurcation. The differential diagnosis is extensive and includes thyroiditis, migraine headache, aneurysm of the carotid system, temporomandibular joint syndrome, giant cell arteritis, and head and neck neoplasms. A correct diagnosis is usually achieved by careful review of the history and physical examination. Laboratory studies are obtained primarily to exclude other causes. Successful treatment is most often effected with the use of nonsteroidal antiinflammatory drugs, although other treatment modalities may be needed. A series of 25 patients treated during the past 10 years is presented. The symptoms, physical findings, appropriate laboratory studies, and a treatment protocol for this uncommon entity are detailed.