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Acute Right Neck Pain
This case shows a patient presenting with acute right-sided neck pain, ultimately diagnosed as TIPIC syndrome (transient perivascular inflammation of the carotid artery), also known as acute idiopathic carotidynia.
Imaging overview:
Axial contrast-enhanced CT of the neck demonstrates a skin marker over the area of maximal tenderness with homogenous, poorly enhancing soft-tissue thickening surrounding the right carotid bifurcation. Axial post-contrast T1 fat-suppressed MRI confirms intensely enhancing circumferential perivascular soft tissue, greater on the right than the normal left side. Axial 2D TOF MRA shows no luminal narrowing, dissection, or aneurysm, supporting an inflammatory rather than structural vascular process.
Clinical insight:
TIPIC is a self-limited inflammatory condition that presents as focal pain and tenderness over the carotid bifurcation. Recognition of characteristic perivascular enhancement with preserved arterial lumen is crucial so that more serious causes, such as carotid dissection or vasculitis, are not missed but also not overcalled. Patients typically improve with conservative or anti-inflammatory therapy, and follow-up imaging often shows resolution of the perivascular changes.
Case courtesy of Daniel Warren, MD
University of Illinois Carle College of Medicine – Carle Foundation Hospital