We prospectively compared CT angiography (CTA) of the common carotid artery bifurcation using two different techniques with conventional angiography in patients with suspected stenoses of the internal carotid arteries in 20 symptomatic patients. Ten patients (Group 1) received 60 cc of contrast (medium 2 cc/sec) and CTA was acquired using 5 mm slices, reconstructed at 3 mm slice thickness. Ten patients (Group 2) received 90 cc of contrast (medium 3 cc/sec) and CTA was acquired using 3 mm slices reconstructed at 1 mm slice thickness. All CTA studies were postprocessed using maximum intensity projection algorithm. Stenoses were graded prospectively from CT angiograms and compared with selective conventional catheter angiograms. In Group 1, CTA overestimated the degree of narrowing in 9 of 10 stenoses proven by conventional angiograms. We interpreted 2 nearly occluded internal carotid arteries, 2 with moderate and marked stenoses, and 2 with no narrowings, but fibromuscular dysplasia on conventional angiograms as occluded on CTA, and 3 vessels as showing marked stenoses, not confirmed by angiography. CTA clearly depicted 1 mild stenosis, 4 normal bifurcations, and 6 occluded internal carotid arteries. In Group 2, CTA overestimated two stenoses; a correct diagnosis was made in 7 normal bifurcations, 3 mild, 2 moderate and 2 severe stenoses, 2 near occlusions, and 2 occlusions. Ulcerations were missed by CTA regardless of the technique utilized.

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Lymphatic and mixed malformations are rare and variable in presentation. They arise due to errors in vascular and lymphatic formation during early embryonic development. This leads to persistent infiltration of lymph fluid into soft tissues and causes a locally invasive mass with pathologic sequelae. Departing from historically descriptive terminology, such as ''cystic hygroma,'' lymphatic malformations are now categorized as macrocystic, microcystic, or mixed lesions, based on size. Advances in imaging modalities, such as ultrasonography and magnetic resonance imaging, have made accurate characterization of these lesions possible and ultimately allow for early diagnosis and implementation of appropriate treatment based on the morphology of the lymphatic malformation. Management of lymphatic malformations can be quite challenging, and a multidisciplinary approach is most effective for optimum aesthetic and functional outcomes. New discoveries in the molecular biology of lymphatic malformations have provided treatment targets and established a role for pharmacotherapy. Sclerotherapy, laser, and radiofrequency ablation have all proven to be effective as minimally invasive treatment options for lymphatic malformations. Surgical intervention has a role in the treatment of focal lesions recalcitrant to these less invasive techniques. Operative planning is dictated by clinical goals, size, anatomic location, characteristics, and extent of infiltration.

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