Transient perivascular inflammation of the carotid artery (TIPIC) syndrome is an uncommon but important cause of unilateral neck pain, now recognised as a distinct clinicoradiologic entity. This case-based presentation will review the key sonographic features, especially eccentric perivascular thickening at the carotid bifurcation, and focus on the clinical and imaging clues that should alert sonographers to the diagnosis in everyday practice.

During a carotid examination, the mid/distal internal carotid artery may be less scrutinised due to unintentional focus on the carotid bifurcation. This presentation explores pathology that can be found in the mid/distal internal carotid artery and highlights the need to diligently investigate beyond the carotid bulb.

Patent Foramen Ovale (PFO) is a common cardiac anomaly affecting approx 1 in 4 people. It is a significant risk factor for stroke due to paradoxical embolism.

Transcranial Doppler Ultrasound with agitated saline contrast (bubble test) is often a more sensitive compared to a Trans Oesophageal Echo and easier to obtain than a Trans Thoracic Echo.

The use of TCD PFO detection at the Royal Adelaide Hospital has changed the way strokes of Embolic Stroke of Underdetermined Source (ESUS) are managed in South Australia.

Learn about the RAH experience, how to perform a TCD bubble test and explore the range of pathologies encountered.

Introduction: Carotid Doppler ultrasound is a common vascular examination that consumes significant time, resources, and costs. However, its diagnostic yield for surgically significant carotid stenosis is relatively low.
Objective: To develop a rapid carotid duplex protocol that begins with a simplified examination of the carotid arteries (B-mode and colour Doppler) and then adds additional imaging parameters (spectral Doppler) based on disease severity.
Methods: Patients referred for diagnostic carotid artery examination were invited to participate in the study. The results of the rapid examination were compared to the results of the traditional carotid duplex examination.
Results: Data from 250 patients (500 carotid arteries) were obtained. Patient age ranged from 23 to 92 years (median of 74 years). The traditional carotid examination was considered the gold standard and provided the following diagnoses for per carotid artery: normal (n=135, 27.0%), <50% stenosis (n=316, 63.2%), 50-59% stenosis (n=11, 2.2%), 60-69% stenosis (n=8, 1.6%), 70-79% stenosis (n=9, 1.8%), 80-89% stenosis (n=6, 1.2%), >90% stenosis (n=8, 1.6%), near occlusion (n=0, 0.0%), and occlusion (n=7, 1.4%). For the detection of 50-59% carotid artery stenosis, the rapid examination achieved sensitivity of 96.0% and specificity of 100.0%. For the detection of 60% carotid artery stenosis of any category, the rapid examination achieved 100% sensitivity and specificity. Time required to complete the rapid examination ranged from 21.2 seconds to 216.9 seconds.
Conclusion: The rapid examination is a novel screening test to exclude significant carotid artery stenosis, which can dramatically reduce examination time and cost without compromising diagnostic accuracy.