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Disappearing flapping plaque in the internal carotid artery
Peter R Coombs1, Rowena Downie, Thanh G Phan
1Ultrasoud: Diagnostic Imaging, Southern Health, Monash Medical Centre, Clayton, Victoria, Australia. Peter.Coombs@med.monash.edu.au
Annals of Vascular Surgery
|January 5, 2010
Summary
A rare mobile atheromatous plaque at the internal carotid artery (ICA) origin was identified in a patient experiencing an acute neurologic event. Differentiating this plaque from thrombus is crucial for effective patient management strategies.
Area of Science:
- Vascular Surgery
- Neurology
- Radiology
Background:
- Mobile atheromatous plaque at the internal carotid artery (ICA) origin is a rare sonographic finding.
- Acute thrombosis is an unusual complication, often secondary to plaque hemorrhage, ulceration, dissection, or embolus.
Observation:
- An 89-year-old male presented with an acute neurologic event.
- Carotid ultrasound revealed a mobile, heterogeneous atheromatous plaque at the right ICA origin.
- This plaque differed from acute thrombus due to its echogenicity, narrow attachment, and lack of underlying intima.
Findings:
- Computed tomography angiography and repeat ultrasound confirmed plaque disappearance within 24 hours.
- The patient's symptoms worsened during this period, with only small intimal flaps remaining.
- The mobile atheromatous plaque resolved spontaneously, leaving residual intimal flaps.
Implications:
- Distinguishing mobile atheroma from thrombus is critical for guiding treatment decisions.
- Current management strategies for thrombus (e.g., thrombolysis) may not be appropriate for mobile atheroma.
- This case highlights the importance of accurate diagnosis for optimizing therapeutic interventions in cerebrovascular disease.
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