Article
Neck hematoma caused by spontaneous rupture of common carotid artery
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Authors
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Veit Maria Hofmann
- Universitätsklinik und Poliklinik für HNO-Heilkunde, Kopf- und Halschirurgie, Halle, Germany
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Joerg Ukkat
- Universitätsklinik für Allgemein-, Visceral- und Gefäßchirurgie, Halle, Germany
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Kerstin Neumann
- Universitätsklinik und Poliklinik für HNO-Heilkunde, Kopf- und Halschirurgie, Halle, Germany
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Annett Pudszuhn
- Universitätsklinik und Poliklinik für HNO-Heilkunde, Kopf- und Halschirurgie, Halle, Germany
| Published: | July 22, 2009 |
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Outline
Text
Perforations of common carotid artery are a rare but life threatening emergency.
Failed puncture of jugular veins, sharp-edged or blunt traumata are known conditions leading to sudden development of a neck hematoma. Inflammatory combustion of a vessel, like arteritis could lead spontaneously or combined with a trigger to a perforation. The literature describes so called spontaneous artery ruptures without known causes.
We present the case of a 57-year-old female who presented with a rapidly increasing left cervical mass, initially misdiagnosed as a neck phlegmona. There were no signs of dyspnoe or dysphagia. The patient had a history of non-alcoholic liver cirrhosis with TIPS -Implantation 6 weeks before. In the course of the diagnostic work up the patient showed the following ENT-signs: Left vocal cord dysfunction, left Horners syndrome. Blood pressure, pulse rate, laboratory investigation was normal. A contrast enhanced CT-scan showed a lateral cervical mass including the common coronary artery. The internal jugular vein showed an abruption at a length of 8 cm. Colour duplex sonography revealed beside the hematoma suspected mass a pendular flow caudal to the carotid bifurcation. Congruent to the CT-scan-findings an intraarterial calcified plaque structure was found downstream of this suspected perforation.
The patient was transferred to the vascular surgery department and operated on. Intraoperative findings confirmed exactly the diagnosis that was made by colour-duplex-sonography. A slit-like lesion of the common carotid artery of 2 mm length right before the outlet of the internal carotid artery was found. A transendarteriectomy with consecutive patch-reconstruction has been performed.
Neck hematoma as a result of a carotid artery rupture is a rare differential diagnosis of a sudden progressive latereral cervical mass. In this patient the perforation of the common carotid artery could be caused by a failed pucture of the internal jugular vein while the TIPS-Implantation 6 weeks ago in combination with a prior damage of the vessel through the cacified carotisplaque.
