Fanilda S BarrosSonographer, Brazil
Title: Transient Perivascular Inflammation of the Carotid Artery (TIPIC): Vascular Ultrasonography Role
Transient Perivascular Inflammation of the Carotid Artery (TIPIC syndrome – Transient Perivascular Inflammation of the Carotid Artery) is a rare and underdiagnosed condition. In this presentation, I will illustrate through a case report, TIPIC (Transient Perivascular Inflammation of the Carotid Artery), including topics such as clinical evaluation, indication and findings of vascular ultrasound (VUS), treatment and follow-up, with a brief review of the literature.
Extracranial carotid duplex ultrasonography (DUS) was requested within 2 weeks after sudden onset of unilateral, evolving, neck pain. Signs and symptoms related to a 53 year-old man included local swelling, skin changes, increased, local sensations, and high sensitivity to palpation. Atherosclerotic risk factors were not noted. He had contralateral radiation therapy, neck and face, and a DUS within normal limits one yearearlier. Medication treatment lasted 2 weeks, and resolved the patient’s complains. Magnetic resonance including angiography complemented DUS. Literature informationwas conferred to solidify the diagnostic likelihood.
Standard carotid arterial DUS was performed, then repeated 4 months post treatment.Potential differential diagnoses were acute dissection, Takayasus' arteritis, giant cell arteritis, vasculitis, jugular vein thrombosis, lymphadenitis, submandibular gland disorder, tumors.
DUS B-mode documented extensive, hypoechogenic, homogeneous plaquing, or tissue, engulfing the arterial wall at the common carotid bifurcation, and expanding into the proximal internal carotid artery. Peak-systolic and end-diastolic velocities (PSV/EDV) at the internal carotid narrowing, 288/129 cm/s, were consistent with a 74%, local stenosis measured in a transverse plane. Plaque width, estimated at almost 6 mm, was related to a 2 mm luminal diameter. Treatment reduced stenosis to 51%, associated to a 3 mm luminal diameter and 3 mm plaque extension approximately. PSV/EDV decreased to 132/62 cm/s. Magnetic resonance imaging and angioresonance (MRI, MRA) showed irregular thickening, with contrast enhancement, in the proximal ICA and bifurcation, corroborating with the DUS findings
Transient Perivascular Inflammation of the Carotid Artery (TIPIC) was the diagnosis, once the term carotidynia has been questioned. Tissue image characterization and intra-tissue contrast Doppler studies may provide needed, extra knowledge about TIPIC causes and effects.