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17 year old man suffered a gunshot wound to the neck and face with massive blood loss. Emergency CT scan of head and neck demonstrates bullet fragments adjacent to a
comminuted jaw fracture (top left image, whitetip arrow). CT scan with contrast shows traumatic laceration of multiple branches of the right carotid artery (top right
image, whitetip arrow). Diagnostic arteriography (lower left image, black arrow) confirms laceration of the right internal carotid artery origin with pseudo-aneurysm
(false aneurysm) formation. Essentially, the bullet has cut the carotid artery and blood is flowing into a pocket within the soft tissues of the neck surrounding the
artery. Following endovascular treatment using stent and coil reconstruction of the vessel, repeat arteriography shows complete occlusion of the pseudo-aneurysm and
normal blood flow in the carotid artery (lower right image, black arrow). |
