CEUS characterization of carotidynia – a case report

Purpose: CEUS is a valuable method for the characterization of carotid plaques. Carotidynia is a rare pain syndrome of unknown etiology. Based on MRI-findings, radiologist claim an inflammation of either the carotid sheath or the carotid wall. This case report demonstrates the vascularization pattern of a twolayered carotidynia lesion and its regression at follow up three weeks later.

Material and methods: A 42-year old patient developed severe pain at the right submandibular region. 3-Tesla MRI and Sonography were performed and carotidynia was diagnosed. Three weeks later follow-up sonography and CEUS were done. The patient has had no neurological complications, pain had almost completely subsided.

Results: In the first imaging both MRI and sonography showed a crescent-shaped thickening of the arterial wall at the carotid bifurcation. There was almost no narrowing of the vessel lumen. Sonographically, a hypoechoic, slightly inhomogenous outer layer could be distinguished from an anechoic inner part. Both CEUS and MRI demonstrated an intensely vascularized outer layer and a non-vascularized inner layer. CEUS with its better spatial resolution and continuous registration was clearly the superior imaging method. Follow up sonography and CEUS showed substantial regression of the outer layer in size and perfusion, whereas the inner layer showed little change.

Fig. 1: ACC CEUS 25 Sek.

Conclusion: High resolution imaging with sonography, CEUS and MRI suggests that in this case there are two distinct layers as a morphological substrate of carotidynia. There is an outer layer with marked perfusion due to inflammation and an inner layer without perfusion.