Teaching Case

Traumatic rupture of the right internal carotid artery with pseudoaneurysm and bleeding

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.

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.