Transient perivascular inflammation of the carotid artery syndrome: diagnostic value of unenhanced MRI and ultrasonography

Transient perivascular inflammation of the carotid artery (TIPIC) syndrome, formerly known as carotidynia, is a rare and benign condition characterized by acute unilateral neck pain and perivascular inflammation in the absence of arterial dissection or stenosis. We describe a woman in her 70s who presented with a 4-day history of right-sided neck and pharyngeal pain. Ultrasonography of the neck revealed eccentric wall thickening of the right common carotid artery with surrounding hypoechoic soft tissue, but without luminal narrowing. Because of her history of asthma, unenhanced magnetic resonance imaging was performed instead of contrast-enhanced computed tomography. Magnetic resonance angiography showed no stenosis or dissection. Fat-suppressed T2-weighted imaging demonstrated high signal intensity around the right common carotid artery, consistent with perivascular oedema, which was not present on imaging performed 7 months earlier; diffusion-weighted imaging revealed no restricted diffusion, supporting an inflammatory rather than ischaemic process. TIPIC syndrome was diagnosed based on her clinical symptoms and imaging findings. She was managed conservatively, and her symptoms resolved spontaneously within 1 week. Follow-up ultrasonography demonstrated complete resolution of the vascular wall thickening and perivascular changes. This case highlights the characteristic imaging features of TIPIC syndrome and emphasizes the importance of considering this entity in patients with unilateral neck pain.