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Internal carotid artery pseudoaneurysm masquerading as a peritonsillar abscess
Janelle A Thomas1, Theodore M Ware, Francis L Counselman
1Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.
The Journal of Emergency Medicine
|April 5, 2002
Summary
Blunt carotid artery injuries, often from car crashes, can cause stroke. Diagnosis relies on imaging, with surgical or endovascular stenting as common treatments for pseudoaneurysms.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Neurology
Background:
- Blunt carotid arterial injuries are rare but serious consequences of neck trauma.
- Motor vehicle crashes are the primary cause, but other blunt force trauma can also lead to these injuries.
- Vascular injuries include dissection, pseudoaneurysm, thrombosis, rupture, and arteriovenous fistula formation.
Observation:
- Patients with internal carotid artery pseudoaneurysm often present with neurological deficits, from minor symptoms to full stroke.
- Physical examination may reveal neck hematoma, bruits, or a pulsatile neck mass, but 50% of cases show no external signs of trauma.
- Symptom onset can be delayed, occurring hours to months after the initial injury.
Findings:
- Angiography remains the gold standard for diagnosing blunt carotid arterial injuries.
- Carotid Doppler ultrasound demonstrates high sensitivity for detecting these vascular injuries.
- Pseudoaneurysms of the internal carotid artery are a significant concern, potentially leading to cerebrovascular events.
Implications:
- Prompt diagnosis and management are crucial to prevent severe neurological outcomes.
- Surgical intervention and endovascular stenting are primary treatment modalities for carotid artery pseudoaneurysms.
- Increased awareness of non-obvious neck trauma is essential for timely identification and treatment of blunt carotid arterial injuries.