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Joseph Junewick, MD FACR
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Focal Carotid Dissection

Case Detail

Anatomy: Neck-Face
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 11 years ago
Updated: over 11 years ago
Tags: PEDS
Modality/Study Types: CT VI
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Teenager shot with a pellet gun. No neurovascular deficit.

Case Images


Focal Carotid Dissection

Clinical Notes

The patient underwent endovascular stent graft.


CT – Scout image shows the metallic foreign body in the percervical soft tissue edema. Axial, sagittal and coronal images show a focal linear intimal defect and hematoma around the carotid sheath.

Arteriogram – Selective left common carotid injection confirms the focal injury.


Dissection is rare in penetrating trauma, occurring in fewer than 2% of patients (most blunt traumatic dissections result from hyperextension and rotation, hyperflexion, or lesser trauma and occasionally hypertension, fibromuscular dysplasia, or connective tissue diseases).

Cervical dissections may be clinically silent; 50% of patients present with a normal or nonfocal examination consisting of headaches and neck pain. The other 50% can develop symptoms such as transient ischemic attacks, Horner’s syndrome, or a neck bruit caused by a dissection with slow propagation of thrombus or delayed embolization.

CT angiography is an accurate nonivasive means of detection of carotid dissection. Endovascular stent grafts are increasingly utilized for treatment.


LeBlang SD and Nunez DB. Non-invasive imaging of cervical vascular injuries. AJR (2000); 174:1269-1278.


John Quick MD

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