0:01

Using our Mnemonic of vitamin C and D,

0:03

we're going to skip over the acquired and metabolic

0:06

disorders because they usually do not

0:08

affect the carotid sheath. However,

0:11

we do have one example of disease that is listed

0:15

under Idiopathic variety, and that is carotidinia.

0:19

Carotidinia is an entity that has been extensively

0:23

explored, and we still don't really know

0:26

a lot about the etiology of it.

0:28

So let's look at a quick reference here.

0:32

So this is from the American Journal of

0:34

Neuroradiology 2017, and they looked at a large

0:40

number of hundreds of cases of the so-called

0:43

carotidinia, and this is an entity that is associated

0:47

with tenderness and pain at the carotid bifurcation.

0:51

What they found was that there was abnormal soft

0:55

tissue associated with the carotid artery in a high

0:59

rate of these patients, and the median diameter of

1:02

this thickened tissue was 5 to 20

1:07

mm in a superior-inferior dimension.

1:10

The wall of the carotid artery was thickened, and

1:13

sometimes they found soft intimal

1:15

plaque associated with it. Now,

1:18

the three components of the carotidinia, which they

1:22

want to rename transient perivascular inflammation

1:26

of the carotid artery or Typical disease,

1:28

are the abnormal soft tissue,

1:30

the thickened carotid wall, and then the recovery

1:33

within about two weeks of this disease process with

1:38

nonsteroidal anti-inflammatory drugs. Now,

1:41

that recovery is the symptomatic recovery.

1:44

Sometimes you will see the thickening around the

1:46

carotid wall or the abnormal soft tissue, which

1:48

persists for months to years thereafter.

1:51

What was interesting was in one-third of the

1:55

patients who had this inflammatory

1:57

condition of the carotid artery,

1:59

they found other autoimmune diseases like

2:02

Hashimoto's thyroiditis or Crohn's disease or

2:06

ulcerative colitis or other autoimmune

2:09

disorders that were associated.

2:11

And in some cases, the carotid artery flare-up

2:15

occurred at the same time as, for example,

2:17

the GI or pulmonary flare-up.

2:20

So this occurred, as I said,

2:23

in one-third of the cases.

2:24

The other two-thirds, there were no other associated

2:28

diseases that occurred with carotidinia, and

2:31

it was isolated idiopathic carotidinia.

2:35

So an interesting disorder, but as it was stated,

2:38

usually you do see something that is occurring

2:42

at the site of the patient's tenderness.

2:44

This case was a bit of the worst case of carotidinia

2:50

that is around, and you can see that there was both

2:53

luminal narrowing as well as soft tissue thickening

2:56

around the carotid artery. Miraculously,

2:59

with nonsteroidal anti-inflammatory

3:01

drugs, this all went away.

3:03

And that's how we came to the diagnosis of this

3:07

idiopathic carotidinia in this individual.