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Life-threatening carotid haemorrhage following blunt trauma

Published online by Cambridge University Press:  22 December 2009

A Kumar ,
J Ahmed ,
N Reading ,
S Patil  and
S Jayaraj
A Kumar*
Affiliation:
ENT Department, Whipps Cross University Hospital NHS Trust, London, UK
J Ahmed
Affiliation:
ENT Department, Whipps Cross University Hospital NHS Trust, London, UK
N Reading
Affiliation:
ENT Department, Whipps Cross University Hospital NHS Trust, London, UK
S Patil
Affiliation:
ENT Department, Whipps Cross University Hospital NHS Trust, London, UK
S Jayaraj
Affiliation:
ENT Department, Whipps Cross University Hospital NHS Trust, London, UK
*
Address for correspondence: Dr A Kumar, ENT SHO, Whipps Cross University Hospital NHS Trust, London E11 1NR, UK. E-mail: [email protected]
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Abstract

Introduction:

We report a case of internal carotid arterial damage following blunt neck trauma. This rare mechanism of injury demands a high index of suspicion to enable prompt specialist management.

Case report:

A 22-year-old man presented to hospital after sustaining blunt neck trauma. Rapid onset of stridor necessitated an emergency tracheostomy. Computed tomography angiography demonstrated a tear of the right internal carotid artery, which was repaired surgically.

Discussion:

Blunt carotid vessel injury, although rare, has a high mortality rate. Mechanisms of injury include hyperextension and contralateral neck rotation, a direct blow to the vessel, and laceration by adjacent bony structures. The ‘gold standard’ investigation for suspected blunt carotid vessel injury is catheter angiography, although this carries a small risk of stroke. Computed tomography angiography is a less invasive, alternative investigation which has almost equivalent accuracy. The extent of damage to the vessel wall will dictate treatment. In our literature review, we discuss the presentation, investigation and different treatment modalities available.

Conclusion:

This case highlights an unusual mechanism of carotid artery injury, with a delayed, potentially fatal presentation. Such injury demands a high index of suspicion, and confirmation with specific investigations. Management is hazardous and requires experienced personnel in all aspects of care.

Keywords

Internal Carotid ArteryNeckTraumaAngiography
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 9 , September 2010 , pp. 1030 - 1032
Copyright
Copyright © JLO (1984) Limited 2009

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