Presentation
Syncopal episode upon waking up. Hypertension. Head pain.
Patient Data
Images A- B: Ultrasound images of CCA demonstrating an echogenic intimal flap and reverse circulation in the false lumen.
Image C: Left common artery with a slight increase in PSV - 138cm/s.
Image D: Duplex ultrasound of false lumen in CCA demonstrates damped biphasic flow with atypical spectral wave, VPS low (43cm/seg) and reverse protodiastole.
Axial non-contrast CT may demonstrate only subtle findings like displacement of atherosclerotic calcification into the lumen. It would also be possible evaluate for distal complications like a high-density mural hematoma (not visible in this patient).
Axial, coronal and sagittal with contrast-enhanced CT: findings were an intimal flap with double lumen, affecting ascending aorta, arch, descending, abdominal aorta and common iliac bilaterally. At the level of supra-aortic trunks, dissection of the brachiocephalic trunk with involvement of the common carotid artery and proximal third of the internal carotid is also observed. The left common carotid artery is completely dissected. Left renal artery is dissected proximally.
Case Discussion
In a patient without specific neurological symptoms, ultrasound demonstrates an intimal echogenic flap in the common carotid artery.
Color Doppler and Duplex ultrasound images showed patent vessels without thrombus, a biphasic wave with an atypical spectral signal and hemodynamically non-significant stenosis. CT angiography with contrast confirmed the findings.
Doppler ultrasound helps in the early diagnosis. CT angiography correlation is the gold standard for its diagnosis - confirming the echographic findings, classifying the dissection and evaluating complications.
Early diagnosis is important because dissection is a risk factor for recurrent embolic cerebrovascular events.
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