Wk 4, Case 35 - Review

Noncontrast head CT. CTA of the head and neck.

CLINICAL INDICATION: Neck pain

TECHNIQUE:
Axial noncontrast CT images of the head were initially performed followed by Axial CTA images of the head were obtained from the vertex to the superior mediastinum following administration of intravenous contrast. Sagittal and coronal reformations as well as 3D MIP reconstructions were also provided.

COMPARISON: None

FINDINGS:

Head CT:
No evidence of acute intracranial hemorrhage, mass effect, or herniation. No evidence of acute transcortical infarct. No hyperdense vessel sign.

Global parenchymal volume loss. Encephalomalacia/gliosis of the left occipital lobe. Mild chronic appearing periventricular and subcortical white matter hypoattenuation is present. No acute or aggressive bone or soft tissue process. Paranasal sinuses and mastoid air cells are clear. Surgical changes of prior left craniectomy. Hyperostosis internus frontalis. Patient is edentulous. Streak artifact from metallic device noted in the region of the left sylvian fissure. Right cataract lens replacement.

Head CTA:
No evidence of ICA or proximal MCA contrast cutoff. No high-grade stenosis, or other vascular abnormality involving the intracranial carotid and vertebral arteries, vessels of the circle of Willis, or their proximal branches. Left fetal PCA. Calcifications are associated with the intracranial carotid and vertebral arteries. Dural venous sinuses are grossly patent.

Neck CTA:
Right internal carotid artery dissecting pseudoaneurysm measuring 10 x 8 mm (series 4, image 255). Similar left internal carotid dissecting pseudoaneurysm 7 x 7 mm (image 254). No dissection, aneurysm, or stenosis of the vertebral arteries. Internal jugular veins are not opacified due to angiographic timing.

No masses or suspicious enhancement within the pharynx, larynx or thyroid gland. No pathologically enlarged nodes. The airway remains patent. Lung apices are clear. Multilevel degenerative changes of the spine without acute osseous abnormality.

IMPRESSION:
Bilateral internal carotid dissecting pseudoaneurysms measuring up to 10 mm on the right and 7 mm on the left. Given symmetry of findings, a predisposing condition such as fibromuscular dysplasia could be considered.