Case 10 - Dissection, pseudo aneurysm

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

EXAMINATION:

Noncontrast head CT. CTA of the head and neck.

CLINICAL INDICATION: 70-year-old male with a history of psoriasis currently admitted with miliary TB.

Known left common carotid artery pseudoaneurysm.

TECHNIQUE: Axial noncontrast CT images of the head were initially performed followed by Axial CTA images of the head were obtained from the vertex to the superior mediastinum following administration of intravenous contrast. Sagittal and coronal reformations as

well as 3D MIP reconstructions were also provided.

COMPARISON: MRI brain, 2/8/2020.

FINDINGS:

CT HEAD:

No acute intracranial hemorrhage. No extra-axial fluid collection, mass effect, or midline shift. Gray-white matter differentiation is preserved.

Ventricles are normal in caliber. Basal cisterns are patent. Mild calcification of the cavernous internal carotid arteries.

Layering fluid in the right maxillary sinus. Nasogastric tube partly seen. Small right and moderate left mastoid effusions. Orbits are normal.

CTA HEAD:

Petrous, cavernous, paraclinoid, supraclinoid segments of the internal carotid arteries are patent. M1 and M2 segments of the middle cerebral arteries are patent bilaterally. Left A1 segment is hypoplastic. Right A1 segment and bilateral A2 segments of the anterior cerebral arteries are patent bilaterally. Anterior communicating artery is patent.

V4 segments of the vertebral arteries are patent and are left dominant. Basilar artery is patent. P1 and P2 segments of the posterior cerebral arteries are patent and normal in caliber. Superior cerebellar arteries are patent.

No evidence of aneurysm, flow-limiting stenosis, or dissection of the intracranial vasculature.

CTA NECK:

Redemonstration of a lobulated pseudoaneurysm arising from the lateral aspect of the left proximal common carotid artery with mild narrowing of the carotid artery lumen which remains patent. The carotid artery demonstrates wall hemorrhage. The

pseudoaneurysm neck measures approximately 0.8 cm in craniocaudal dimension, not significantly changed. Compared to 2/25/2020, the pseudoaneurysm sac is mildly enlarged. For example, craniocaudal dimension measures approximately 4.3 cm, previously 3.9 cm. There is also increasingly heterogeneous internal contrast opacification within aneurysm sac, which may be related to internal thrombosis. No new pseudoaneurysm.

Redemonstration of moderate inflammatory changes surrounding the aneurysm sac, with stable mass effect on the right internal jugular vein. Mildly decreased size of surrounding left cervical lymphadenopathy.

There is a 3 vessel branching pattern of the aortic arch. Fusiform dilatation of the right proximal to mid subclavian artery measuring 2.2 cm in maximum diameter, unchanged. The origins of the vertebral arteries are patent. Mild atherosclerosis of the carotid bulbs without significant stenosis by NASCET criteria. The cervical segments of the internal carotid arteries are patent. External carotid arteries are patent.

Cervical segments of the vertebral arteries are patent.

Multifocal opacities within the right and left lungs. Layering secretions within the trachea. Right central venous catheter is partly seen. Unchanged large right retropectoral lymph node. Mediastinal lymphadenopathy.

IMPRESSION:

1. No CT evidence of acute intracranial abnormality.

2. Patent intracranial vasculature with no high-grade stenosis, aneurysm, or dissection.

3. Mild interval enlargement of a left-sided common carotid artery dissecting pseudoaneurysm since 2/25/2020. Stable mild narrowing of the left common carotid artery.

4. Stable fusiform dilatation of the proximal right subclavian artery.

5. Extensive lung infiltrations with mediastinal adenopathy.

CTA NECK W/WO IV CONTRAST

INDICATION: pseudoaneurysm concern on recent neck ultrasound

TECHNIQUE: Multiple-row detector helical CT examination of the neck with intravenous contrast. Sagittal and coronal reformations were generated.