Clinical History
Traumatic rupture of the right internal carotid artery with pseudoaneurysm and bleeding
Imaging Findings
The patient was involved into a traffic accident. Sitting in the back he was sleeping when the accident happened but was protected by a safety belt. He was admitted with a large neck hematoma predominantly on the right side; no hemiplegia was present.
Direct angiography was performed (Fig. 1) via a right transfemoral access showing an ill-defined margin of the proximal portion of the right internal carotid artery in an ap view with markedly slowed flow in the distal segment s of the internal carotid artery (Fig. 1 a). Lateral and oblique views showed large pseudoaneurysm of the internal carotid artery with extravasation (Fig. 1 b ) and compression of the true carotid arterial lumen. Nevertheless, the distal segment of the carotid artery remained patent (Fig. 1 c) with no sign of dissection.
The patient underwent successful emergency surgery for direct repair of the carotid rupture.
Discussion
Origin of this traumatic carotid arterial rupture is most likely due to a whiplash injury by the safety belt. The fact that the patient sleeping in a more lying position may have resulted in a more cervical position of the safety belt exposing the carotid artery to direct trauma.
Differential Diagnosis List
Traumatic rupture of the right internal carotid artery with pseudoaneurysm and bleeding
Final Diagnosis
Traumatic rupture of the right internal carotid artery with pseudoaneurysm and bleeding
