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Carotid Artery Pseudoaneurysm in Neck
Bronwyn E. Hamilton, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Carotid artery pseudoaneurysm (CAPA)
            • Synonyms

              • Carotid artery false aneurysm
              • Biffl grade III blunt carotid injury
              • May be indistinguishable from carotid blowout (in postradiotherapy setting)
            • Definitions

              • CAPA: Focal carotid artery outpouching
              • Partial or complete disruption of vessel wall
              • Contained by adventitial sleeve or surrounding hematoma

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Angiographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      • Angiographic Grading of Blunt Carotid Injuries

                                        • Surgical Implications by Grade

                                          Selected References

                                          1. Vogrig A et al: Stroke in patients with COVID-19: clinical and neuroimaging characteristics. Neurosci Lett. 743:135564, 2021
                                          2. Wu Y et al: Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection. BMC Neurol. 20(1):445, 2020
                                          3. Chengazi HU et al: Pathology of the carotid space. Insights Imaging. 10(1):21, 2019
                                          4. Hakimi R et al: Imaging of carotid dissection. Curr Pain Headache Rep. 23(1):2, 2019
                                          5. McNally JS et al: Magnetic resonance imaging and clinical factors associated with ischemic stroke in patients suspected of cervical artery dissection. Stroke. 49(10):2337-44, 2018
                                          6. Mohan S et al: Computed tomography angiography of the neurovascular circulation. Radiol Clin North Am. 54(1):147-62, 2016
                                          7. Paraskevas KI et al: Fate of distal false aneurysms complicating internal carotid artery dissection: a systematic review. Eur J Vasc Endovasc Surg. 52(3):281-6, 2016
                                          8. Bodanapally UK et al: Vascular injuries to the neck after penetrating trauma: diagnostic Performance of 40- and 64-MDCT Angiography. AJR Am J Roentgenol. 205(4):866-72, 2015
                                          9. Scott WW et al: Clinical and radiographic outcomes following traumatic Grade 1 and 2 carotid artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey. J Neurosurg. 122(5):1196-201, 2015
                                          10. Foreman PM et al: Extracranial traumatic aneurysms due to blunt cerebrovascular injury. J Neurosurg. 120(6):1437-45, 2014
                                          11. Paulus EM et al: Blunt cerebrovascular injury screening with 64-channel multidetector computed tomography: more slices finally cut it. J Trauma Acute Care Surg. 76(2):279-83; discussion 284-5, 2014
                                          12. Roberts DJ et al: Diagnostic accuracy of computed tomographic angiography for blunt cerebrovascular injury detection in trauma patients: a systematic review and meta-analysis. Ann Surg. 257(4):621-32, 2013
                                          13. Chokshi FH et al: 64-MDCT angiography of blunt vascular injuries of the neck. AJR Am J Roentgenol. 196(3):W309-15, 2011
                                          14. Reis F et al: Involvement of the oral cavity in a carotid pseudoaneurysm of an adolescent treated by an endovascular procedure. Acta Otolaryngol. 130(1):190-2, 2010
                                          15. Chern JJ et al: Endovascular stenting of traumatic extracranial carotid artery dissections in the pediatric population: a case report. Cases J. 2:171, 2009
                                          16. Ellens DJ et al: Radiotherapy-induced common carotid pseudoaneurysm presenting with initially occult upper airway hemorrhage and successfully treated by endovascular stent graft. Am J Otolaryngol. 31(3):195-8, 2009
                                          17. Provenzale JM et al: Comparison of test performance characteristics of MRI, MR angiography, and CT angiography in the diagnosis of carotid and vertebral artery dissection: a review of the medical literature. AJR Am J Roentgenol. 193(4):1167-74, 2009
                                          18. Vertinsky AT et al: Comparison of multidetector CT angiography and MR imaging of cervical artery dissection. AJNR Am J Neuroradiol. 29(9):1753-60, 2008
                                          19. Goode S et al: Intraplaque haemorrhage mimicking carotid pseudoaneurysm on magnetic resonance angiography. Br J Radiol. 80(959):e271-4, 2007
                                          20. Elijovich L et al: The emerging role of multidetector row CT angiography in the diagnosis of cervical arterial dissection: preliminary study. Neuroradiology. 48(9):606-12, 2006
                                          21. DeFatta RJ et al: Extracranial internal carotid artery pseudoaneurysm. Int J Pediatr Otorhinolaryngol. 69(8):1135-9, 2005
                                          22. Posacioglu H et al: Large pseudoaneurysm of the carotid artery in Behçet's disease. Tex Heart Inst J. 32(1):95-8, 2005
                                          23. Hagiwara A et al: The "botryoid sign": a characteristic feature of rhabdomyosarcomas in the head and neck. Neuroradiology. 43(4):331-5, 2001
                                          24. Weissman JL et al: Thrombosed aneurysm of the cervical carotid artery: avoiding a retrospective diagnosis. Radiology. 190(3):869-71, 1994
                                          25. Haynes DS et al: Internal carotid artery aneurysms presenting as neck masses. Otolaryngol Head Neck Surg. 107(6 Pt 1):787-91, 1992
                                          26. Smith RB 3rd et al: Post-operative false aneurysms of the carotid artery. Am Surg. 36(6):335-41, 1970
                                          27. Buscaglia LC et al: False aneurysm after carotid endareterectomy. JAMA. 209(10):1529, 1969
                                          28. Deysine M et al: Traumatic false aneurysm of the cervical internal carotid artery. Surgery. 66(6):1004-7, 1969
                                          29. STONE PW et al: Pseudoaneurysm of the right common carotid artery. N Y State J Med. 60:1239-41, 1960
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Carotid artery pseudoaneurysm (CAPA)
                                                    • Synonyms

                                                      • Carotid artery false aneurysm
                                                      • Biffl grade III blunt carotid injury
                                                      • May be indistinguishable from carotid blowout (in postradiotherapy setting)
                                                    • Definitions

                                                      • CAPA: Focal carotid artery outpouching
                                                      • Partial or complete disruption of vessel wall
                                                      • Contained by adventitial sleeve or surrounding hematoma

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Angiographic Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              • Angiographic Grading of Blunt Carotid Injuries

                                                                                • Surgical Implications by Grade

                                                                                  Selected References

                                                                                  1. Vogrig A et al: Stroke in patients with COVID-19: clinical and neuroimaging characteristics. Neurosci Lett. 743:135564, 2021
                                                                                  2. Wu Y et al: Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection. BMC Neurol. 20(1):445, 2020
                                                                                  3. Chengazi HU et al: Pathology of the carotid space. Insights Imaging. 10(1):21, 2019
                                                                                  4. Hakimi R et al: Imaging of carotid dissection. Curr Pain Headache Rep. 23(1):2, 2019
                                                                                  5. McNally JS et al: Magnetic resonance imaging and clinical factors associated with ischemic stroke in patients suspected of cervical artery dissection. Stroke. 49(10):2337-44, 2018
                                                                                  6. Mohan S et al: Computed tomography angiography of the neurovascular circulation. Radiol Clin North Am. 54(1):147-62, 2016
                                                                                  7. Paraskevas KI et al: Fate of distal false aneurysms complicating internal carotid artery dissection: a systematic review. Eur J Vasc Endovasc Surg. 52(3):281-6, 2016
                                                                                  8. Bodanapally UK et al: Vascular injuries to the neck after penetrating trauma: diagnostic Performance of 40- and 64-MDCT Angiography. AJR Am J Roentgenol. 205(4):866-72, 2015
                                                                                  9. Scott WW et al: Clinical and radiographic outcomes following traumatic Grade 1 and 2 carotid artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey. J Neurosurg. 122(5):1196-201, 2015
                                                                                  10. Foreman PM et al: Extracranial traumatic aneurysms due to blunt cerebrovascular injury. J Neurosurg. 120(6):1437-45, 2014
                                                                                  11. Paulus EM et al: Blunt cerebrovascular injury screening with 64-channel multidetector computed tomography: more slices finally cut it. J Trauma Acute Care Surg. 76(2):279-83; discussion 284-5, 2014
                                                                                  12. Roberts DJ et al: Diagnostic accuracy of computed tomographic angiography for blunt cerebrovascular injury detection in trauma patients: a systematic review and meta-analysis. Ann Surg. 257(4):621-32, 2013
                                                                                  13. Chokshi FH et al: 64-MDCT angiography of blunt vascular injuries of the neck. AJR Am J Roentgenol. 196(3):W309-15, 2011
                                                                                  14. Reis F et al: Involvement of the oral cavity in a carotid pseudoaneurysm of an adolescent treated by an endovascular procedure. Acta Otolaryngol. 130(1):190-2, 2010
                                                                                  15. Chern JJ et al: Endovascular stenting of traumatic extracranial carotid artery dissections in the pediatric population: a case report. Cases J. 2:171, 2009
                                                                                  16. Ellens DJ et al: Radiotherapy-induced common carotid pseudoaneurysm presenting with initially occult upper airway hemorrhage and successfully treated by endovascular stent graft. Am J Otolaryngol. 31(3):195-8, 2009
                                                                                  17. Provenzale JM et al: Comparison of test performance characteristics of MRI, MR angiography, and CT angiography in the diagnosis of carotid and vertebral artery dissection: a review of the medical literature. AJR Am J Roentgenol. 193(4):1167-74, 2009
                                                                                  18. Vertinsky AT et al: Comparison of multidetector CT angiography and MR imaging of cervical artery dissection. AJNR Am J Neuroradiol. 29(9):1753-60, 2008
                                                                                  19. Goode S et al: Intraplaque haemorrhage mimicking carotid pseudoaneurysm on magnetic resonance angiography. Br J Radiol. 80(959):e271-4, 2007
                                                                                  20. Elijovich L et al: The emerging role of multidetector row CT angiography in the diagnosis of cervical arterial dissection: preliminary study. Neuroradiology. 48(9):606-12, 2006
                                                                                  21. DeFatta RJ et al: Extracranial internal carotid artery pseudoaneurysm. Int J Pediatr Otorhinolaryngol. 69(8):1135-9, 2005
                                                                                  22. Posacioglu H et al: Large pseudoaneurysm of the carotid artery in Behçet's disease. Tex Heart Inst J. 32(1):95-8, 2005
                                                                                  23. Hagiwara A et al: The "botryoid sign": a characteristic feature of rhabdomyosarcomas in the head and neck. Neuroradiology. 43(4):331-5, 2001
                                                                                  24. Weissman JL et al: Thrombosed aneurysm of the cervical carotid artery: avoiding a retrospective diagnosis. Radiology. 190(3):869-71, 1994
                                                                                  25. Haynes DS et al: Internal carotid artery aneurysms presenting as neck masses. Otolaryngol Head Neck Surg. 107(6 Pt 1):787-91, 1992
                                                                                  26. Smith RB 3rd et al: Post-operative false aneurysms of the carotid artery. Am Surg. 36(6):335-41, 1970
                                                                                  27. Buscaglia LC et al: False aneurysm after carotid endareterectomy. JAMA. 209(10):1529, 1969
                                                                                  28. Deysine M et al: Traumatic false aneurysm of the cervical internal carotid artery. Surgery. 66(6):1004-7, 1969
                                                                                  29. STONE PW et al: Pseudoaneurysm of the right common carotid artery. N Y State J Med. 60:1239-41, 1960