Vasculitis of the internal carotid artery in Wegener's granulomatosis: comparison of ultrasonography, angiography, and MRI

A 37-year old male with newly diagnosed, untreated Wegener's granulomatosis including glomerulonephritis, sinusitis, conjunctivitis, arthralgias, and positive cANCA, developed a pulsating tumor in the left submandibular regio n and a reversible ischemic neurologic deficit. Ultrasonography revealed bo th a hyperechoic wall thickening of the left proximal internal carotid arte ry as is known in Takayasu's arteritis and a surrounding hypoechoic region typical for perivasculitis. The wall thickening and the perivascular infilt rate could be less clearly seen by MRI. Ultrasonography, angiography, and M RI demonstrated a 3 cm long, 30% stenosis. Angiography and MRI additionally found a more distally located kinking of the internal carotid artery that was missed by ultrasonography. Carotid artery vasulitis is a rare complicat ion of Wegener's granulomatosis. In this case ultrasonography was superior to angiography and MRI to visualize the artery wall and the surrounding tis sue, but it failed to evaluate the whole distance of the vessel.