PMC7985240_01
(a) Longitudinal ultrasound view showing LCC wall thickening (arrows). 0.30 cm relates to vessel wall thickness. (b) Coronal CTA view showing no LCC wall thickening. (c) Axial MRI view showing prominent LCC wall thickening. (d) PET/CT scan showing hypermetabolic mediastinal and hilar lymphadenopathy. *Dimensions not to scale. CTA : computed tomography angiography; LCC : left common carotid; PET : positron emission tomography; MRI : magnetic resonance imaging.
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fig1
Doppler ultrasound (US) displayed evident LCC wall thickening, without luminal stenosis (Figure 1(a)). Head and neck computed tomography angiography (CTA) scan, however, showed no vasculitic lesions (Figure 1(b)). This time, he was hospitalized, and a head and neck magnetic resonance imaging (MRI) scan was completed, showing prominent LCC wall thickening, compatible with vasculitis (Figure 1(c)). While no active vasculitis was observed, hypermetabolic mediastinal and hilar lymphadenopathy was seen (Figure 1(d)).
(a) Numerous noncaseating sarcoid-like granulomas (orange arrowheads). (b) Well-formed granuloma (orange arrowheads) with a developing Schaumann body (black arrowhead).
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fig2
Pathology results demonstrated noncaseating granulomas (Figure 2), with negative acid fast and silver stains.
Longitudinal ultrasound view showing a noticeable improvement in LCC wall thickening (arrows) after corticosteroid therapy, as compared to Figure 1(a). 0.12 cm relates to vessel wall thickness. *Dimensions not to scale. LCC : left common carotid.
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fig3
Repeat neck US, within 6 weeks of therapy, revealed improvement of the sonographic findings (Figure 3).