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544

Ultrasonic Demonstration Carotid Artery N.

Reed

Dunnick,1

Thomas

H.

boli,

emboli may arise peripheral venous

from

or

from

more

commonly

that

requires the

thrombus demonstration

The

].

arteriography,

risk

of

resulting of in-

an invasive

dislodging

further

a case

mural em-

procedure of the

fragments

in which

thrombus

within

carotid

artery was demonstrated preoperatively using both a gray scale static scanner and

ultrasound

a mechanically

Case

[1

[2, 3]. We present

the common with

and

from intracardiac sites with paradoxical

intraarterial

plaques

clot

carries

thrombus

sectored

real-time

scanner.

Report

A 58-year-old routine

woman

physical

infiltrating

in the

Institutes

She

had

rence.

Cranial

This

in the was

stroke.

rhagic

onset

arteries

were

common

region, as

On

raphy common

carotid

The

patient

ectomy. gradual

evidence

tumor.

improvement.

discharged

later.

a left

At

evidence

that of

Received

after

time

she

recurrent

January

9,

Diagnostic Radiology N. Reed Dunnick.

133:544-545,

right artery

transverse

scans

carotid

arteniog-

intraarterial

bifurcation

thrombus

(fig.

2). The

right

normal.

common

carotid

showed was

thromboendarter-

an intraluminal

treated

the with

blood

patient

walking

with

clot

showed

chemotherapy

She was last seen

admission.

was

carotid

assistance

and

3 months

and

had

no

tumor.

.

.. Biomedical

8 cm

carotid the

left

and

Postoperatively,

She

1 month

The

recur-

a nonhemor-

of the

common

carotid

examination of

when

to the

enhancement. with

longitudinal

was

underwent

Pathologic no

with

arteriogram

a an

of decreased

ultrasonography

normal.

on both

2 cm of the

later,

after

area

ultrasound

scale

an approximately

to within

on for

referred

no contrast

1 ). Subsequent

(fig.

demonstrated

extending

gray

an

consistent

and

appeared

echoes

thrombus

with

most

performed.

internal

then 4 months

showed

left panietal

arteniography

indicating

mass

3 years

was

hemiparesis

Carotid

contained

until

She

tomography

artery

breast

mastectomy

chemotherapy.

interpreted

carotid

well

wall.

for

right a radical

did

chest of right

computed

finding

had

and

right

of Health

sudden

attenuation

a palpable She

carcinoma,

recurred

National

had

examination.

ductal

tumor

AJR

from

atheromatous

traarterial

H. Schuette,2

in the Common

Shawker1

Cerebral

thrombi,

William

of Thrombus

Engineering

accepted

1 979;

Department, and

September

after Clinical

Instrumentation

1979;

0361

revision Center, Branch,

-803x/79/1

May

Fig.

thrombus. A, Gray scale ultrasound examination of projection. Normal right common carotid artery (arrowechoes in left common carotid artery (arrow). B, Examination of left common carotid artery (arrows) in longitudinal projection confirms presence of internal echoes from extensive thrombus. neck head)

1 -Intraarterial in transverse and internal

1 7, 1979.

Bldg.

10,

Division

333-0544

Room

6521

1 , National

of Research

Service,

$00.00

Institutes National

of Health, Institutes

Bethesda, of Health,

MD

20014.

Bethesda,

Address MD

20014.

reprint

requests

to

AJR:133,

September

CASE

1979

Fig. 2.-Left common carotid arteniogram. Large intraarterial thrombus (arrows) in midportion of vessel extends

to

within

2

cm

of

carotid

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bifurcation.

545

REPORTS

The

common

with

carotid

ultrasonic

arteries

scanning

can

of

the

be

routinely

neck.

visualized

While

the

arterial

lumen of the common carotid artery can be evaluated by transverse and longitudinal static scans performed over the vessel, the examination is facilitated by the use of a highresolution of the

real-time pulsating

scanner vessel.

echo-free. Carotid pears as a constant the

fluid-filled

safely.

by artery

constant

it can

ultrasound

disease,

lumen

is needed then

small

appears

in this case, apof echoes within

be

after

dem-

performed

examination

since

visualization

arterial

If an arteriogram

ultrasound,

A negative

carotid

gives

normal

artery thrombosis, as intraluminal collection

lumen.

onstration

that

The

does

more

not preclude

accumulations

of throm-

bus, such as ulcerating plaque, must still be demonstrated by arteriography. Because carotid artery thrombosis is rare we do advocate ultrasound as a routine screening procedure patients

with

newer

real-time

give

ischemic

a high

using

resolution

instruments can time ultrasound cedure

symptoms.

scanners

for

image

high of

the

not for

On the other hand, the frequency transducers carotid

artery.

If these

visualize stenoses, then it is likely that real will become an acceptable screening pro-

detecting

currently using lation who are

carotid

real-time at high

occlusive

disease.

We

are

ultrasound in a very select popurisk for carotid arterial occlusive

disease.

REFERENCES 1

Discussion thrombus

is life

in a vessel

threatening.

Conventional

supplying

cerebral

pro-

can demonstrate this condition only by arteriogIn addition to the usual risks of cerebral angiography,

there

is the

stenosis,

added

risk

Rapid-sequence decreased flow finding that not

intraluminal

of

dislodging

a fragment

of

[4].

2.

of TH,

Head

AM,

the

Potts Robboy

fatal complication 102:307, 1972

3. the

radionuclide studies may demin the involved vessel, but this is a is usually due to carotid arterial clot

Newton

cir-

radiographic

cedures raphy.

thrombus. onstrate nonspecific

BB, Fields

Kilgore

Radiology

Intraarterial culation

.

Howieson diology

4.

WS: Arterial Skull DG,

Mosby,

stroke

and

TH, Potts DG, St. Louis, Griep RJ, Wise G, Marty tion

by

311-316,

intravenous 1970

artery

in adults,

1 974,

mural

thrombi,

angiography,

angiography.

a

Radiology

edited

Mosby, 1974, pp 1034-1046 A: Detection of carotid artery

radionuclide

by

pp 2310-2343

from

Angiography,

in

edited

catheterization.

of cerebral Brain:

disease

Angiography,

St. Louis,

of axillary

Skull

Brain:

SJ: Embolic

J: Complications of the

occlusive

and

in Raby Newton

obstruc-

Radiology

97: