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Penetrating Neck Injuries: Helical CT Angiography for Initial Evaluation¹

¹ From the Departments of Radiology (F.M., J.A.S., D.M.P., J.C., J.E.G.) and Surgery, Divisions of Trauma Surgery (C.M., A.S.) and Vascular Surgery (G.G.), Universidad de Antioquia, Medellín, Colombia. Received May 29, 2001; revision requested June 26; revision received November 9; accepted January 7, 2002. Address correspondence to F.M., Department of Radiology (R019), University of Miami School of Medicine/Jackson Memorial Hospital, Ryder Trauma Center, 1611 NW 12th Ave, West Wing 279, Miami, FL 33136 (e-mail: fmunera@med.miami.edu).

View larger version (106K): [in a new window]   Figure 1. Lateral multiplanar maximum intensity pixel projection CT image clearly depicts the site of the right internal carotid arterial occlusion (arrow).

View larger version (132K): [in a new window]   Figure 2a. Right common carotid arterial pseudoaneurysms. (a) Transverse CT image demonstrates the extravascular collections of contrast material (straight arrows). A small intimal flap (curved arrow) is seen within the arterial lumen. There is also enlargement of the adjacent soft tissues because of swelling and hematoma. (b) Three-dimensional shaded-surface display image demonstrates the extravascular collections of contrast material (arrows).

View larger version (147K): [in a new window]   Figure 2b. Right common carotid arterial pseudoaneurysms. (a) Transverse CT image demonstrates the extravascular collections of contrast material (straight arrows). A small intimal flap (curved arrow) is seen within the arterial lumen. There is also enlargement of the adjacent soft tissues because of swelling and hematoma. (b) Three-dimensional shaded-surface display image demonstrates the extravascular collections of contrast material (arrows).

View larger version (141K): [in a new window]   Figure 3. Transverse CT image obtained at the level of the thyroid gland shows a posteromedial filling defect (arrow) within the arterial lumen because of left common carotid arterial partial thrombosis in a patient with a gunshot wound injury. Adjacent muscular swelling is also depicted.

View larger version (155K): [in a new window]   Figure 4. Transverse CT image shows tracheal posterior wall disruption (arrow) caused by penetrating injury to the neck. Secondary air leakage produces significant subcutaneous emphysema (*). No vascular lesion was demonstrated.

View larger version (136K): [in a new window]   Figure 5. Transverse CT image shows a large bullet (*) located in the right lateral side of the spinal canal and causing cord compression. There is also C2 fracture (arrow) involving the left posterior arch. Despite beam-hardening artifacts, vascular anatomy, including vertebral arteries, was not obscured.