0:01

This was a patient who had pain over the right side

0:04

of the neck in the area from C5 to C3.

0:08

And if we start from above for a change,

0:11

we're going to be looking at

0:12

the right side of the neck.

0:15

And as we look at the entrance to the

0:18

petrous internal carotid arteries,

0:20

the carotid arteries appear symmetric.

0:23

However, as we go down,

0:25

we start to see an area of thickening around the

0:30

right internal carotid artery and extending to

0:34

some of the external carotid artery branches.

0:37

This thickened soft tissue extends to

0:41

the common carotid artery as well.

0:43

What I'm looking at is this tissue around the

0:47

right common carotid artery. Comparing it,

0:50

the left common carotid artery,

0:53

as you can see, it goes down into the neck,

0:57

but really, I'd say it begins right around

1:00

this junction here,

1:01

which is remarkably very close to the C3,

1:04

C4 level.

1:05

So this was an example of an individual whose main

1:10

issue was tenderness associated with the common

1:14

carotid artery and proximal right internal carotid

1:18

artery with thickening of the wall.

1:20

And this tenderness resolved using non-steroidal

1:23

anti-inflammatory drug. So some might say, well,

1:26

maybe.

1:26

How do you know that this isn't

1:28

wall injury from dissection?

1:30

One of the things that is typical of a dissection

1:33

is it usually does not cross a bifurcation.

1:36

It's rare for it to cross a bifurcation.

1:38

So when you have something that's involving both the

1:41

common carotid artery as well as

1:44

the internal carotid artery,

1:45

that's unusual for a dissection in the wall

1:49

and the residual of that.

1:50

So in this case,

1:51

it was an idiopathic inflammatory process.

1:55

Let's just take a quick look at the reconstructions.

1:58

This is showing that thick

2:00

tissue along the common carotid artery.

2:05

See all this thickened tissue and extending up to

2:08

the internal carotid artery above the bifurcation?

2:13

The lumen of the vessel, however,

2:16

actually doesn't look all that bad,

2:18

so it's not as if there was luminal narrowing.

2:20

It was really the circumferential involvement

2:22

of the blood vessel.