A Case of Idiopathic Carotidynia Diagnosed by Non-contrast CT

Abstract

Idiopathic carotidynia is a rare disease of unknown origin characterized by unilateral cervical pain of carotid-sheath origin and soft-tissue infiltration surrounding the carotid sheath on imaging examination. Herein, we report the case of a 65-year-old male who presented with the chief complaint of left cervical pain. Otorhinolaryngological examination showed mild swelling and tenderness of the left carotid sheath. A plain CT showed soft-tissue infiltration surrounding the left carotid sheath at the level of the left hyoid bone. Laboratory test results were normal. These clinical manifestations and the findings of CT were consistent with a diagnosis of idiopathic carotidynia. The above symptoms were relieved by one-day treatment with an anti-inflammatory drug. Although soft-tissue infiltration of the carotid sheath of in cases of carotidynia on contrast-enhanced CT has been described in previous reports, it was observed on plain, non-contrast CT images in this patient, which allowed avoidance of any anxiety from the point of view of potential contrast medium allergy in our case. From the reports in the literature and data from our own case, we propose a revised classification of carotidynia, dividing it into five categories (i.e. idiopathic, migrainous, arteriosclerotic, drug-induced, and others).