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Acute Idiopathic Carotidynia
Bronwyn E. Hamilton, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • TransIent perivascular inflammation of carotid artery (TIPIC) syndrome
                • Idiopathic or sclerosing (inflammatory) pseudotumor
                • Idiopathic carotiditis
                • Fay syndrome
              • Definitions

                • Self-limited inflammatory disorder of carotid artery causing carotid wall thickening & pain
                • Proposed TIPIC criteria
                  • Acute pain overlying carotid artery ± radiation to head
                  • Eccentric perivascular infiltration on imaging
                  • Exclude other vascular/nonvascular diagnosis by imaging
                  • Improvement within 14 days
                    • Spontaneously or with antiinflammatory treatment
                  • Minor criterion of self-limited intimal soft plaque suggested
                • Prior International Headache Society Classification Committee (IHSCC) criteria for diagnosis: Self-limited illness with ≥ 1 of following: Tenderness to palpation, swelling, increased pulsations over carotid
                • Not currently recognized by International Classification of Headache Disorders, 3rd edition in 2018

              IMAGING

              • General Features

                • Imaging Recommendations

                  • Ultrasonographic Findings

                    • MR Findings

                      • CT Findings

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Mumoli N et al: Transient perivascular inflammation of the carotid artery (TIPIC) syndrome in a patient with COVID-19. Int J Infect Dis. 108:126-8, 2021
                                            2. Scoppettuolo P et al: Multimodal imaging for a TIPIC syndrome case. Acta Neurol Belg. ePub, 2021
                                            3. Rafailidis V et al: Role of multi-parametric ultrasound in transient perivascular inflammation of the carotid artery syndrome. Ultrasound. 27(2):77-84, 2019
                                            4. Ulus S et al: Imaging spectrum of TIPIC syndrome: validation of a new entity with vessel wall imaging. Clin Neuroradiol. 30(1):145-57, 2018
                                            5. Abrahamy M et al: Ultrasound for the diagnosis of carotidynia. J Ultrasound Med. 36(12):2605-9, 2017
                                            6. Lecler A et al: TIPIC syndrome: beyond the myth of carotidynia, a new distinct unclassified entity. AJNR Am J Neuroradiol. 38(7):1391-8, 2017
                                            7. Behar T et al: Comparative evolution of carotidynia on ultrasound and magnetic resonance imaging. J Mal Vasc. 40(6):395-8, 2015
                                            8. Young JY et al: CT findings in a patient with bilateral metachronous carotidynia. Clin Imaging. 39(2):305-7, 2015
                                            9. Berzaczy D et al: Imaging of a case of benign carotidynia with ultrasound, MRI and PET-CT. Wien Klin Wochenschr. 125(21-22):719-20, 2013
                                            10. Pina S et al: Burkitt lymphoma as a cause of carotidynia: imaging features. A case report. Neuroradiol J. 26(1):18-20, 2013
                                            11. Azar L et al: Perivascular carotid inflammation: an unusual case of carotidynia. Rheumatol Int. 32(2):457-9, 2012
                                            12. Comacchio F et al: Carotidynia: new aspects of a controversial entity. Acta Otorhinolaryngol Ital. 32(4):266-9, 2012
                                            13. Schaumberg J et al: Carotidynia: magnetic resonance imaging and ultrasonographic imaging of a self-limiting disease. Clin Neuroradiol. 21(2):91-4, 2011
                                            14. da Rocha AJ et al: Imaging contribution for the diagnosis of carotidynia. J Headache Pain. 10(2):125-7, 2009
                                            15. Park JK et al: CT imaging features of carotidynia: a case report. J Neuroimaging. 19(1):84-5, 2009
                                            16. Amaravadi RR et al: [18F.] Fluorodeoxyglucose positron-emission tomography-CT imaging of carotidynia. AJNR Am J Neuroradiol. 29(6):1197-9, 2008
                                            17. Taniguchi Y et al: Is carotidynia syndrome a subset of vasculitis? J Rheumatol. 35(9):1901-2, 2008
                                            18. Kosaka N et al: Imaging by multiple modalities of patients with a carotidynia syndrome. Eur Radiol. 17(9):2430-3, 2007
                                            19. Tardy J et al: Carotidynia: a new case for an old controversy. Eur J Neurol. 14(6):704-5, 2007
                                            20. Second Headache Classification Subcommittee of the International Headache Society. Classification and diagnosis criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia. 24 (Suppl):70-1, 2004
                                            21. Upton PD et al: Histologic confirmation of carotidynia. Otolaryngol Head Neck Surg. 129(4):443-4, 2003
                                            22. Burton BS et al: MR imaging of patients with carotidynia. AJNR Am J Neuroradiol. 21(4):766-9, 2000
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • TransIent perivascular inflammation of carotid artery (TIPIC) syndrome
                                                          • Idiopathic or sclerosing (inflammatory) pseudotumor
                                                          • Idiopathic carotiditis
                                                          • Fay syndrome
                                                        • Definitions

                                                          • Self-limited inflammatory disorder of carotid artery causing carotid wall thickening & pain
                                                          • Proposed TIPIC criteria
                                                            • Acute pain overlying carotid artery ± radiation to head
                                                            • Eccentric perivascular infiltration on imaging
                                                            • Exclude other vascular/nonvascular diagnosis by imaging
                                                            • Improvement within 14 days
                                                              • Spontaneously or with antiinflammatory treatment
                                                            • Minor criterion of self-limited intimal soft plaque suggested
                                                          • Prior International Headache Society Classification Committee (IHSCC) criteria for diagnosis: Self-limited illness with ≥ 1 of following: Tenderness to palpation, swelling, increased pulsations over carotid
                                                          • Not currently recognized by International Classification of Headache Disorders, 3rd edition in 2018

                                                        IMAGING

                                                        • General Features

                                                          • Imaging Recommendations

                                                            • Ultrasonographic Findings

                                                              • MR Findings

                                                                • CT Findings

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Staging, Grading, & Classification

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Mumoli N et al: Transient perivascular inflammation of the carotid artery (TIPIC) syndrome in a patient with COVID-19. Int J Infect Dis. 108:126-8, 2021
                                                                                      2. Scoppettuolo P et al: Multimodal imaging for a TIPIC syndrome case. Acta Neurol Belg. ePub, 2021
                                                                                      3. Rafailidis V et al: Role of multi-parametric ultrasound in transient perivascular inflammation of the carotid artery syndrome. Ultrasound. 27(2):77-84, 2019
                                                                                      4. Ulus S et al: Imaging spectrum of TIPIC syndrome: validation of a new entity with vessel wall imaging. Clin Neuroradiol. 30(1):145-57, 2018
                                                                                      5. Abrahamy M et al: Ultrasound for the diagnosis of carotidynia. J Ultrasound Med. 36(12):2605-9, 2017
                                                                                      6. Lecler A et al: TIPIC syndrome: beyond the myth of carotidynia, a new distinct unclassified entity. AJNR Am J Neuroradiol. 38(7):1391-8, 2017
                                                                                      7. Behar T et al: Comparative evolution of carotidynia on ultrasound and magnetic resonance imaging. J Mal Vasc. 40(6):395-8, 2015
                                                                                      8. Young JY et al: CT findings in a patient with bilateral metachronous carotidynia. Clin Imaging. 39(2):305-7, 2015
                                                                                      9. Berzaczy D et al: Imaging of a case of benign carotidynia with ultrasound, MRI and PET-CT. Wien Klin Wochenschr. 125(21-22):719-20, 2013
                                                                                      10. Pina S et al: Burkitt lymphoma as a cause of carotidynia: imaging features. A case report. Neuroradiol J. 26(1):18-20, 2013
                                                                                      11. Azar L et al: Perivascular carotid inflammation: an unusual case of carotidynia. Rheumatol Int. 32(2):457-9, 2012
                                                                                      12. Comacchio F et al: Carotidynia: new aspects of a controversial entity. Acta Otorhinolaryngol Ital. 32(4):266-9, 2012
                                                                                      13. Schaumberg J et al: Carotidynia: magnetic resonance imaging and ultrasonographic imaging of a self-limiting disease. Clin Neuroradiol. 21(2):91-4, 2011
                                                                                      14. da Rocha AJ et al: Imaging contribution for the diagnosis of carotidynia. J Headache Pain. 10(2):125-7, 2009
                                                                                      15. Park JK et al: CT imaging features of carotidynia: a case report. J Neuroimaging. 19(1):84-5, 2009
                                                                                      16. Amaravadi RR et al: [18F.] Fluorodeoxyglucose positron-emission tomography-CT imaging of carotidynia. AJNR Am J Neuroradiol. 29(6):1197-9, 2008
                                                                                      17. Taniguchi Y et al: Is carotidynia syndrome a subset of vasculitis? J Rheumatol. 35(9):1901-2, 2008
                                                                                      18. Kosaka N et al: Imaging by multiple modalities of patients with a carotidynia syndrome. Eur Radiol. 17(9):2430-3, 2007
                                                                                      19. Tardy J et al: Carotidynia: a new case for an old controversy. Eur J Neurol. 14(6):704-5, 2007
                                                                                      20. Second Headache Classification Subcommittee of the International Headache Society. Classification and diagnosis criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia. 24 (Suppl):70-1, 2004
                                                                                      21. Upton PD et al: Histologic confirmation of carotidynia. Otolaryngol Head Neck Surg. 129(4):443-4, 2003
                                                                                      22. Burton BS et al: MR imaging of patients with carotidynia. AJNR Am J Neuroradiol. 21(4):766-9, 2000