Noninvasive imaging of carotid giant pseudoaneurysm

A 54-year-old man presented an acute stroke in the right middle cerebral artery territory. The carotid duplex ultrasound revealed an aneurismatic mass in the right proximal internal carotid artery (ICA) with a lumen and an organized thrombus inside. The multislice angio-CT (MSACT) showed a giant saccular pseudoaneurysm involving the right ICA. Surgical resection of the aneurysm was performed, with proximal anastomosis between internal and external carotid artery. Pathological study revealed a pseudoaneurysm with a thrombosed wall.

Spontaneus ICA pseudoaneurysms are a rare cause of stroke that must be considered in the differential diagnosis of cervical masses. Duplex ultrasound and carotid MSACT are noninvasive methods that may provide an accurate diagnosis.