Aneurysms of the extracranial carotid arteries are rare and account for 0.4-1% of all arterial aneurysms and about 4% of all peripheral arterial aneurysms. We report a case of a 53-year-old male who presented to the emergency department complaining of generalized abdominal pain. Computed tomography showed an incidental finding of infrarenal abdominal aortic aneurysm (AAA). Upon further evaluation with ultrasound, the patient was found to have a right internal carotid artery aneurysm.
The patient was referred to the vascular service for evaluation and repair of the infrarenal AAA. A pre-operative carotid ultrasound was performed. The patient did not have any history of trauma, nor any known family history of aneurysmal disease. The patient has a known history of hypertension and hyperlipidemia. The patient stated he has smoked 2 packs a day for approximately 35 years.
Duplex ultrasound revealed a partially thrombosed right internal carotid artery aneurysm. The aneurysm extended from the carotid bifurcation into the internal carotid artery (ICA). The aneurysm measured, 1.6 x 2.0 cm. The residual lumen measured 1.1 x 0.9 cm. The ICA thrombus appears hypoechoic and was confined to the proximal 2 cm of the ICA. Color flow imaging demonstrated a patent residual lumen which was approximately 50% of the aneurysmal area. Velocities were within normal limits throughout the ICA. The contralateral ICA had no evidence of an aneurysm. With the information obtained on ultrasound, the patient underwent carotid artery reconstruction with the use of PTFE. Follow up ultrasound verified success of the carotid bypass and determined ICA patency.
Ultrasound was a valuable tool to identify, diagnose, and treat this rare aneurysm. Ultrasound was successfully used during the treatment and follow up for this patient.
Tanisha Commodore, RVS, RVT