Teaching Video NeuroImage: Transient Perivascular Inflammation of Carotid Artery Syndrome Demonstrated by Contrast-Enhanced Ultrasonography

A 52-year-old male patient presented with acute left-sided neck pain and tenderness. Inflammatory and vasculitis workup was normal. Carotid ultrasonography (CUS) showed intimal hypoechoic plaque around the left carotid bifurcation with surrounding perivascular hypoechoic lesion, corresponding to the site of tenderness (Figure, A). Contrast-enhanced ultrasonography (CEUS) with perflubutane revealed numerous microbubbles within the perivascular tissue, but no contrast enhancement in the intimal plaque (Figure, B and G; Video). Contrast-enhanced fat-saturated T1-weighted MRI confirmed enhancing perivascular tissue with mild luminal narrowing, consistent with perivascular inflammation (Figure, C). The pain resolved spontaneously within 2 weeks without anti-inflammatory treatment. Three months later, CUS and MRI demonstrated reduction of the perivascular tissue, and follow-up CEUS confirmed resolution of perivascular enhancement (Figure, D–F, H; Video). The intimal plaque persisted. Transient Perivascular Inflammation of the Carotid Artery (TIPIC) syndrome was diagnosed. TIPIC syndrome is characterized by transient inflammation around the carotid bifurcation.¹ CEUS effectively visualized and monitored perivascular inflammation.²