Journal of General Internal Medicine

, Volume 32, Issue 12, pp 1403–1404 | Cite as

Giant Cell Arteritis with Carotidynia

  • Kiyoshi Shikino
  • Shiho Yamashita
  • Masatomi Ikusaka
Clinical Practice: Clinical Images


carotidynia double ring enlarged temporal artery temporal arteritis 
A 74-year-old woman presented with 6 weeks of fevers and right neck pain. At the time of symptom onset, she also experienced bilateral temporal headache with scalp allodynia, which resolved within 3 weeks. Physical examination revealed a pulseless, enlarged right temporal artery (Fig. 1) and a tender right carotid artery. The erythrocyte sedimentation rate was 78 mm/h. Contrast-enhanced computed tomography (CT) revealed wall thickening of the thoracic aorta and its carotid and subclavian branches, with a double-ring appearance (Fig. 2). The patient was diagnosed with giant cell arteritis (GCA) and treated with oral prednisolone. Within 10 days, the patient’s symptoms had improved.
Figure 1

Enlarged temporal artery (arrows).

Figure 2

Contrast-enhanced CT revealed wall thickening involving the thoracic aorta with a poorly enhanced internal ring and an enhancing outer ring, described as a “double-ring” appearance (arrows).

GCA is a vasculitis of medium and large vessels. It rarely occurs before the age of 50 years. In one study, headache was present in 86% of cases.1 However, the headache may be progressive, spontaneously subside, or wax and wane in intensity.2 Carotid artery tenderness has been reported in 7% of GCA cases.3 Temporal artery biopsy remains the gold standard for the diagnosis of GCA.4 CT and magnetic resonance angiography can be used to demonstrate large vessel involvement.5 , 6 Ultrasonography7 and PET-CT8 are also being evaluated as possible diagnostic tools, but are not yet reliable testing modalities.


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Kiyoshi Shikino
    • 1
  • Shiho Yamashita
    • 1
  • Masatomi Ikusaka
    • 1
  1. 1.Department of General MedicineChiba University HospitalChiba CityJapan

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