Post-operative partially thrombosed extracranial internal carotid artery aneurysm

Case contributed by Sebastian Tschauner
Diagnosis certain


Known facial skin cancer. Outside ultrasound reported an enlarged cervical perivascular lymph node on the right side. Patient referred to follow-up sonography of the previously described lymph node.

Patient Data

Age: 80 years
Gender: Male

Cervical Rt at bifurcation...


Cervical Rt at bifurcation level of the common carotid artery

The patient has noticed a painless circumscribed swelling on the right side of his neck for more than a year.

A scar is noted on the right side of the patient's neck. When asked, he reports prior carotid endarterectomy some years ago.

On the ultrasound images there is irregular widening of the internal right carotid artery with an adjacent mixed-echoic oval lesion extending into the sternocleidomastoid muscle.

Turbulent flow recognized in the aneurysmatic artery.

Images are suggestive of a partially thrombosed carotid artery aneurysm.

Irregularly configured, fusiform aneurysm of the internal carotid artery measuring 2 x 1.5 x 3 cm is noted on the right side.

There are surgical clips at the bifurcation level of the common right carotid artery, indicating previous surgery.

Narrowed CT window to make the thrombosed part of the aneurysm visible.

3D and MIP reconstructions to visualize the vasculature.

With adapted window settings, the thrombosed part of the aneurysm can be seen as hypodense oval lesion extending anteriorly into into the sternocleidomastoid muscle.

Case Discussion

This case shows a partially thrombosed aneurysm of the right extracranial internal carotid artery. The patient had a history of carotid endarterectomy on the right side, years ago.

In the setting of newly diagnosed skin cancer, the thrombosed part of the aneurysm was misinterpreted as a pathologically enlarged lymph node in the prior ultrasound examination.

CT angiography confirmed follow-up sonography findings of an aneurysm.

Multiple further/secondary findings not discussed here.

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