Imaging of traumatic arterial injuries in the neck with an emphasis on CTA

Abstract

Arterial injuries in the neck may be secondary to blunt or penetrating trauma. Because of clinical difficulties in early identification of these injuries as well as their potentially catastrophic consequences, imaging is indispensible in the diagnosis of arterial injuries in the neck. Computed tomography angiography (CTA) has become the initial study of choice in management of these patients. We review the clinical and imaging features of vascular injuries of the neck with special emphasis on CTA.

Management of penetrating neck injuries

“…It is readily available in most trauma centres in Western countries. It is reliable and accurate, with a sensitivity and specificity of 90 and 100 per cent respectively, with a positive predictive value of 100 per cent and a negative predictive value of 98 per cent 1,13,27 . CTA is therefore becoming the diagnostic tool of choice during initial evaluation of stable patients with vascular injury.…”

“…Experience with CTA was limited in the institution at the time of the study, and was not often available after office hours. An advantage of using diagnostic angiography, Nevertheless, for diagnostic evaluation of PNI, CTA has several advantages: it is relatively fast, minimally invasive, and has fewer potential complications 1,13,27 . It is readily available in most trauma centres in Western countries.…”

Computed tomography angiography evaluation of internal carotid artery free-floating thrombus—single-center diagnosis, false-positives, and follow-up

“…In this case, the FFT was superimposed on an underlying traumatic carotid dissection. Both carotid dissections and aneurysms have been described to be associated with FFT, and can be readily identified by CTA in the emergency setting [7,10]. The lack of interval change in the appearance of FFT at serial imaging may help distinguish true FFT lesions from false-positive complex ulcerated plaques, as in case 4.…”

How Do I Manage Penetrating Neck Trauma?

“…Physical examination findings supplemented by CTA should have a prominent role in the selective management of PNTs. CTA has replaced angiography as the initial study of choice in the vascular evaluation of neck injuries (16). Comprehensive physical examination with CTA is adequate for identifying and excluding vascular and aerodigestive injuries after PNTs (17).…”