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Case 7 - Complications of Temporal Bone Injury

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Most of the time when we're considering vascular

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injuries associated with the temporal bone,

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we're able to make the diagnosis and do the evaluation with CTA.

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So anytime you have a fracture of the temporal bone that enters

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the petrous or cavernous portion of the internal carotid artery,

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you want to get a CTA to see whether the vessel is bleeding,

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whether it's dissected or whether it may have a contusion.

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So, here is an example of a patient who has a fracture

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entering the posterior portion of the petrous internal

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carotid artery. And when you do the CTA,

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you see that the carotid artery is missing.

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So there's absence of flow. Here's the normal internal

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carotid artery with contrast within it.

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Here with the green arrow is internal

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carotid artery with no contrast in it.

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And you can see that there is thrombosis

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of the right internal carotid artery.

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We have a little stump here of the supraclinoid internal

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carotid artery, secondary to thrombosis of the blood vessel.

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Another one, fracture going across,

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in this case an oblique oriented fracture.

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But look at this short arrow and you see that their fracture

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is involving the left cavernous internal carotid artery.

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Little telltale sign of the air.

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Here you have evidence of thrombosis of the transverse

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sinus. Here's the normal transverse sinus.

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This is likely secondary to the fracture involving

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the mastoid portion of the temporal bone.

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Here we have blood from, well,

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this is extravasation of iodinated contrast from

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small vessels at the external auditory canal.

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So this is effectively blood products that is free streaming

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into the region around the external auditory canal on the

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left side, secondary to trauma from the fracture involving, in

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this case, largely venous etiology as opposed to arterial

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etiology. If you look at this internal carotid artery,

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you want to see it on multiple sections.

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It doesn't have the homogeneous enhancement,

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and it looks like there's some thickening of the wall here.

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This may be a traumatized carotid artery with dissection.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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