Segmental Carotid Wall Thickening in TIPIC Syndrome: Is the Depiction of Microvascularity the Key to Determining Activity?

Abstract

A 35-year-old man without any systemic diseases, comorbidities or vascular risk factors reported focal cervical pain for 6 days in the right carotid area which worsened on focal palpation. We performed focused ultrasound (US) using broadband linear 14 MHz (14L5, Aplio i800™, Canon Medical Systems) and 18 MHz (i18LX5, Aplio i800™, Canon Medical Systems) transducers and standard musculoskeletal presets to depict the vessel walls and their surroundings. US revealed an eccentric, echoic regional lateral wall thickening of the symptomatic carotid bulb and of the internal carotid artery up to 2.6 mm at a length of about 15 mm. No fibrous plaques or significant stenosis was obvious ([Fig. 1]). Microvascularity within the thickened wall segment was clearly demonstrated by using a special low-flow Duplex mode (“Superb Microvascular Imaging” [SMI©], Canon Medical Systems Europe B.V. Zilverstraat 1, 2718RP Zoetermeer, The Netherlands) ([Fig. 2]).