PMC5632850_01
(a) Axial contrast-enhanced CT scan (soft tissue window) shows poorly delineated thickening of the left carotid bulb wall (arrow). Note obliteration of the pericarotid fatty tissue. Minimal vessel narrowing (<20%) due to fibrolipid plaque (arrowhead). (b, c) Axial and longitudinal views of Doppler US examination show fusiform eccentric wall thickening of the left proximal internal carotid artery (ICA) and external carotid artery (ECA) isoechoic to muscle (arrowheads). (d) Sagittal multiplanar reformatted (MPR) image from a 3D volume turbo spin echo acquisition centered on the left carotid bulb (asterisk) shows no evidence of spontaneously T1 hyperintense parietal hematoma, thus ruling out carotid artery dissection. No aneurysm is seen. (e) Axial T1-weighted MR image reveals a hypointense circumferential lesion involving the left carotid bulb and pericarotid fatty tissue (arrows). (f) Intense enhancement (arrowhead) of the mass-like soft tissue lesion on the axial postcontrast fat-saturated T1-weighted MR image. Note that perivascular enhancement and vessel wall enhancement can be hardly differentiated from one another. ICA: internal carotid artery and ECA: external carotid artery.
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CT showed soft tissue thickening surrounding the distal common carotid artery, the carotid bulb, and the proximal internal carotid artery on the affected side (Figure 1). The internal vessel aspect was normal (Figure 1). No T1 hyperintense parietal carotid hematoma was seen on the fat-saturated T1-weighted sequence (Figure 1).
US longitudinal view (a) and corresponding color Doppler image (b) obtained 4 months later show regression of the fusiform wall thickening (arrowheads) of the left carotid bulb. ICA: internal carotid artery. See for comparison Figures 1(b) and 1(c) obtained 4 months earlier.
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Follow-up Doppler US obtained 4 months later (Figure 2) revealed disappearance of the abnormal soft tissue lesion surrounding the affected carotid bifurcation.