Carotid artery aneurysm

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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239 Carotid artery aneurysm

Instruction

Examine this patient’s neck.

Salient features

History

• History of hypertension

• History of diabetes

• History of smoking

• History of transient ischaemic attacks or an embolic stroke (a neurologic event was the presenting symptom in 37.5–100% of cases in one reported series).

Examination

• Pulsatile swelling along the course of the carotids, usually unilateral (the swelling may be firm) and at the base of the neck.

Proceed as follows:

• Auscultate over the mass for a bruit

• Look for Horner syndrome

• Tell the examiner that you would like to examine:

• all peripheral pulses
• the heart and BP
• the fasting blood sugar.

Diagnosis

This patient has a carotid artery aneurysm (lesion) caused by atherosclerosis (aetiology), and may require surgery before the lesion ruptures (functional status).

Advanced-level questions

How would you manage this patient?

• All patients must be referred to a specialist for either open surgery (a venous conduit, usually the proximal greater saphenous vein is used for arterial continuity) or endovascular approach

• Check urine for sugar

• Serum lipids

• Duplex ultrasonography

• Intravenous carotid digital subtraction angiography or CT angiography (Fig. 239.1).

image

Fig. 239.1 Bilateral aneurysms of the internal carotid arteries (ICA). (A) CT angiography showing aneurysms between the artery origins and the base of the skull. The left aneurysm is thrombosed and the right has a very tortuous distal vessel beyond. (B) Coronal CT angiography shows extensive calcification and atheroma bilaterally with thrombosed left aneurysm. ECA, external carotid artery; S, superior.

(With permission from Roche-Nagle 2009.)

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