PMC10257549_01
(a) Panoramic radiograph: bilateral irregular radio-opaque images in the carotid areas, behind the mandibular angle, at the same level as the third cervical vertebra (C3; green circle). (b) Panoramic radiograph in anterior translation position, allowing better visibility of the latero-cervical opacities.
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fig1
(a) and (b) Axial narrow window CT sections without injection of contrast medium through the third cervical vertebra, revealing hyperdensities peripheral to the carotid artery, located posterolateral to the pharyngeal area, having different shapes: curvilinear "C" shape (a) and globular homogeneous (b). (c) and (d) Coronal CT sections in narrow window without injection of contrast medium through the third cervical vertebra, revealing hyperdensities located laterally to the third cervical vertebra with globular appearance. (e) and (f) Sagittal reconstructions through the cervical hyperdensities, revealing globular calcifications in front of the anterior tubercles of the cervical vertebrae.
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TMJ and to clarify the location and nature of these calcifications, computed tomography (CT) scan was performed. This examination revealed bilateral hyperdense images located in the periphery of the carotid arteries, extending vertically for approximately 5 mm, and presenting different shapes depending on the plane and level of the section (Figures 2(a), 2(b), 2(c), 2(d), 2(e), and 2(f)). Figures 2(a) and 2(b) revealed bilateral homogeneous, globular calcifications in the right carotid artery and "C"-shaped curvilinear calcifications in the left carotid artery.
PMC10257549_02
(a) Panoramic radiograph revealing unilateral irregular radiopaque masses behind the right mandibular angle between C2 and C3 (green circle). (b) Cone beam axial section revealing homogeneous linear and curvilinear calcifications, located posterolateral to the pharyngeal area. (c) Cone beam sagittal section revealing calcifications with a coalescent globular appearance, anterior to the anterior tubercles of the cervical vertebrae. (d) Cone beam coronal section revealing calcifications with a linear, linear-globular appearance, located laterally in the soft tissue. (e) Cervico-encephalic Doppler ultrasound.
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 Figure 3(c) revealed vertical and oblique calcifications having the appearance of coalescing globules.  Figure 3(d) revealed multiple calcifications with linear and/or linear-globular aspect. The patient was referred to her cardiologist who completed the already performed radiological assessment with a cervico-encephalic Doppler ultrasound (CEDU; Figure 3(e)).
PMC10257549_03
Panoramic radiograph revealing bilateral calcification of the stylohyoid ligaments (arrows).
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(a) Cervicofacial CT: 3D reconstruction in posterior view revealing bilateral calcification of the stylohyoid ligaments (right side: blue arrows and left side: green arrows). (b) and (c) Cervicofacial CT: sagittal reconstruction:ossified aspect of the stylohyoid ligaments [right (b) and left (c)] giving the appearance of a long styloid process (arrows). (d) Axial section revealing calcification of roughly rounded appearance with irregular contour, located posterolaterally to the pharyngeal area. (e) Sagittal reconstruction revealing calcification at the level of the left carotid bulb, having an appearance of coalescing globules in front of the anterior tubercles of the fifth cervical vertebra (C5). (f) Coronal reconstruction revealing calcification of the common carotid artery with a linear-globular appearance.
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A cropped and magnified image of Figure 4. Panoramic radiograph on the left side, revealed radiopacity of calcific tone (red circle), projecting to the pre-vertebral soft tissues, opposite to the fifth cervical vertebra (C5).
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Cervico-encephalic Doppler ultrasound.
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Based on these clinical data, he was referred to his cardiologist, and the radiological assessment was completed with CEDU (Figure 7).