EURORAD ESR

Case 1771

Imaging of a cervicocranial shot injury, mimicking a lesion of the left carotid artery

Author(s)
A.Malich, J.P. Heyne, J. Böttcher, D. Sauner, W.A.Kaiser
 
Patient
male, 57 year(s)
 
 
  • Figure 1
    Native initial CT (1h post shooting) giving the location of the bullett
     

    A conventional native-axial CT was performed in 3/3 slices of the skull base followed by native-axial 5/8 imaging of the head. The bullet was visible extracranially, intraosseally, lateral to the left mass of the...

     
    Area of Interest: unknown; Imaging Technique: Native initial CT (1h post shooting) giving the location of the bullett;

    Normal slice of supratentorially located structures. No traumatic lesion, no infarction, no oedema was visible supratentorially.

     
    Area of Interest: unknown; Imaging Technique: Native initial CT (1h post shooting) giving the location of the bullett;
     
     
  • Figure 2
    CT of head and neck after administration of 90ml contrast agent (Ultravist 300) (6 hours after...
     

    The supratentorial brain structures did not show any early signs of infarction.

     
    Area of Interest: unknown; Imaging Technique: CT of head and neck after administration of 90ml contrast agent (Ultravist 300) (6 hours after the shot), 20s delay, 5ml/s flow rate;

    Any flow of the carotid artery (internal arm) on the left side was absent from the mandibular region to the intraclinoidal part.

     
    Area of Interest: unknown; Imaging Technique: CT of head and neck after administration of 90ml contrast agent (Ultravist 300) (6 hours after the shot), 20s delay, 5ml/s flow rate;

    Any flow of the carotid artery (internal arm) on the left side was absent from the mandibular region to the intraclinoidal part. There was a slight chalk falx of the left internal carotid artery visible in the...

     
    Area of Interest: unknown; Imaging Technique: CT of head and neck after administration of 90ml contrast agent (Ultravist 300) (6 hours after the shot), 20s delay, 5ml/s flow rate;

    Any flow of the carotid artery (internal arm) on the left side was absent from the mandibular region to the intraclinoidal part. Cranial to that region, slight contrast enhancement and a slight increase in oedema of...

     
    Area of Interest: unknown; Imaging Technique: CT of head and neck after administration of 90ml contrast agent (Ultravist 300) (6 hours after the shot), 20s delay, 5ml/s flow rate;

    Venous filling of the left jugular vein was delayed; the lumen was not compressed

     
    Area of Interest: unknown; Imaging Technique: CT of head and neck after administration of 90ml contrast agent (Ultravist 300) (6 hours after the shot), 20s delay, 5ml/s flow rate;

    Volume rendering of CTA showing the missing A. carotis interna sinistra

     
    Area of Interest: unknown; Imaging Technique: CT of head and neck after administration of 90ml contrast agent (Ultravist 300) (6 hours after the shot), 20s delay, 5ml/s flow rate;
     
     
  • Figure 3
    Colour Doppler Images

    Occlusion of left carotid artery induced by arteriosclerotic plaques is visible

     
    Area of Interest: unknown; Imaging Technique: Colour Doppler Images;
     
     
A conventional native-axial CT was performed in 3/3 slices of the skull base followed by native-axial 5/8 imaging of the head. The bullet was visible extracranially, intraosseally, lateral to the left mass of the occipital bone, mediodorsal to the carotid canal, 1.5cm lateral to the foramen magnum. No major blood equidense structures were visible in the surroundings of the bullet. The trace of the bullet through the tissues was not clearly demonstrated in the three-dimensional visualisation, but the bullet did traverse the soft tissue close to the carotid canal on the left side. Only a small haematoma with subtle oedema and minor traumatic air pouches (soft tissue emphysema) was visible.
 
Normal slice of supratentorially located structures. No traumatic lesion, no infarction, no oedema was visible supratentorially.
 
The supratentorial brain structures did not show any early signs of infarction.
 
Any flow of the carotid artery (internal arm) on the left side was absent from the mandibular region to the intraclinoidal part.
 
Any flow of the carotid artery (internal arm) on the left side was absent from the mandibular region to the intraclinoidal part. There was a slight chalk falx of the left internal carotid artery visible in the mandibular region.
 
Any flow of the carotid artery (internal arm) on the left side was absent from the mandibular region to the intraclinoidal part. Cranial to that region, slight contrast enhancement and a slight increase in oedema of the neck region were visible.
 
Venous filling of the left jugular vein was delayed; the lumen was not compressed
 
Volume rendering of CTA showing the missing A. carotis interna sinistra
 
Occlusion of left carotid artery induced by arteriosclerotic plaques is visible
 
 
 
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