Ultrasonographic diagnosis of a cervical mass caused by a calcified thrombus as an initial manifestation of Takayasu arteritis

With recent advancement in ultrasound technology and devices, ultrasonography has been widely used in the diagnosis of cervical masses, including benign or malignant lymphadenopathy, struma, cysts, and others. ^1-3 Ultrasonography of superficial organs in the cervical area has also been used for evaluation of carotid artery diseases such as arteriosclerosis and inflammatory diseases. An example of the latter is Takayasu arteritis. It is an inflammatory and stenotic disease of medium and large arteries characterized by a strong predilection for the aortic arch and its branches.^4-6 Its ultrasonographic findings include a homogeneous and concentric increase in the intima-media thickness (IMT) of the carotid artery walls.^7-11 Substantial (>50%) obstruction or occlusion and even dilatation also can be seen.^11,12 Its clinical manifestations vary from generalized symptoms such as malaise, fever, and night sweats to vascular system-related ones such as ischemia and absent pulses.^5,6 We had a patient with a painful mass in the right lateral neck, which was ultrasonographically diagnosed as Takayasu arteritis. There was a calcified thrombus at the bulb leading to total obstruction of the right common carotid artery (CCA) and a substantial increase in the IMT of adjacent artery walls. Here, we describe the ultrasonographic findings and clinical implications of a cervical mass caused by a calcified thrombus as an initial manifestation of Takayasu arteritis.