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Focal Carotid Dissection
Case Detail
| Anatomy: Neck-Face |
 Joseph Junewick, MD FACR |
| Diagnostic Category: Trauma |
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| Created: over 2 years ago |
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| Updated: over 2 years ago |
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| Tags:
PEDS
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| Modality/Study Types:
CT
VI
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Activities:  PDF  ImageJA |
History
Teenager shot with a pellet gun. No neurovascular deficit.
Case Images
Diagnosis
Focal Carotid Dissection
Clinical Notes
The patient underwent endovascular stent graft.
Findings
CT – Scout image shows the metallic foreign body in the percervical soft tissue edema. Axial, sagittal and coronal images show a focal linear intimal defect and hematoma around the carotid sheath.
Arteriogram – Selective left common carotid injection confirms the focal injury.
Discussion
Dissection is rare in penetrating trauma, occurring in fewer than 2% of patients (most blunt traumatic dissections result from hyperextension and rotation, hyperflexion, or lesser trauma and occasionally hypertension, fibromuscular dysplasia, or connective tissue diseases).
Cervical dissections may be clinically silent; 50% of patients present with a normal or nonfocal examination consisting of headaches and neck pain. The other 50% can develop symptoms such as transient ischemic attacks, Horner’s syndrome, or a neck bruit caused by a dissection with slow propagation of thrombus or delayed embolization.
CT angiography is an accurate nonivasive means of detection of carotid dissection. Endovascular stent grafts are increasingly utilized for treatment.
Reference
LeBlang SD and Nunez DB. Non-invasive imaging of cervical vascular injuries. AJR (2000); 174:1269-1278.
Contributor
John Quick MD