0:01

Most of the pseudoaneurysms of the carotid artery

0:04

within the carotid sheath are secondary to trauma or

0:09

from iatrogenic reasons because of previous surgery.

0:13

However, this was an unusual case of an individual

0:17

who had miliary TB.

0:19

We start in the chest, seeing all of these

0:21

infiltrations in the bilateral lung as well

0:25

as seeing axillary lymphadenopathy.

0:29

If we follow up the left common carotid artery

0:32

as it takes off from the aorta,

0:36

what we see is a tortuous segment.

0:39

And then as it enters the left side of the neck,

0:44

you notice that there is this large mass which is

0:49

associated with narrowing of the

0:53

left common carotid artery.

0:56

And there is a little jet effect of contrast

1:02

entering into this abnormal area deep

1:07

to the sternocleidomastoid muscle.

1:08

So let me just point that out right here.

1:12

Here is what I'm talking about.

1:13

This hyperdense mass in the left side of the neck.

1:18

This is the normal ICA lumen which is narrowed.

1:23

And here we see a little jet of contrast coming from

1:27

the internal carotid artery and entering

1:29

into this big slightly hyperdense mass.

1:33

This is a carotid pseudoaneurysm where you have the

1:37

contrast entering into the aneurysm lumen as well as

1:42

areas where there is clot within the wall of the

1:46

pseudoaneurysm. So here we again can see it.

1:50

It's abnormal common carotid artery from the get-go.

1:54

We compare the left common carotid artery to the

1:57

normal right common carotid artery as far as the

2:00

luminal narrowing and then we see the jet effect of

2:03

contrast entering into this mass which is the pseudo

2:07

aneurysm that is associated with

2:10

the common carotid artery.

2:13

Further distally, the common carotid artery assumes

2:17

a more normal shape and a more normal lumen.

2:20

So let's try to see whether we can see

2:22

this on the coronal reconstruction.

2:26

So we identify the carotid artery here,

2:34

the common carotid artery, and we see the area of

2:39

dissection narrowing of the blood vessel and then a

2:44

jet phenomena of contrast coming off of the

2:48

lateral wall of the common carotid artery.

2:50

And we even get a little sense of swirling of

2:54

contrast associated with the pseudoaneurysm

2:57

in the left side of the neck.

2:59

Again, this is an unusual location and etiology

3:03

for this pseudoaneurysm.

3:05

Most of them are going to occur in

3:07

the internal carotid artery,

3:09

further superiorly in the cervical portion of the

3:13

internal carotid artery secondary to trauma.

3:16

This was a case where the presumed etiology was

3:19

tuberculosis affecting the artery leading to a

3:23

pseudoaneurysm in this big "S" in

3:25

the supraclavicular fossa.