R. NICKBRYANMDPATRICIA A.HUDGINSMD
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The neck x-ray film (Figure 1) showed that the airway was compressed on the right side, which caused the patient’s respiratory compromise. A CT scan of the neck demonstrated a large soft tissue mass in the left parapharyngeal and retropharyngeal spaces, which displaced the left common carotid artery laterally and compressed the internal jugular vein. The low density around the medial aspect of the left common carotid artery, with the large hyperdense surrounding mass, was characteristic of carotid artery rupture (Figure 2). However, the carotid angiogram that was obtained before surgery demonstrated a normal configuration without aneurysm, leakage of contrast material, abnormal narrowing, or dilation (Figure 3). Therefore, endovascular treatment of the ruptured carotid artery could not be performed, even though this procedure is safe and effective.1,2 Although our patient’s angiogram showed no abnormalities, a carotid rupture or leak was high in the differential diagnosis because of the CT findings. Besides, no balloon test occlusion was performed during conventional catheter angiography, although it might help avoid stroke if the lesioned vessel must be sacrificed during surgery.
Radiology Quiz Case 2: Diagnosis. Arch Otolaryngol Head Neck Surg. 2005;131(9):825-826. doi:10.1001/archotol.131.9.825-b