Carotid artery injuries are rare with an incidence of 1%–2.6% in trauma patients. They are associated with high morbi-mortality rates, with mortality ranging from 19% to 43%. The diagnosis relies mainly on computed tomography angiography in the emergency setting; however, it is fundamental to be able to suspect carotid artery injuries on non-contrast computed tomography, as the latter is the routine imaging tool for trauma patients. We report the case of a young male, victim of a blunt high velocity motor-vehicle trauma. He was unconscious, with abundant epistaxis and hypovolemic shock. A fracture of the left carotid canal on non-contrast computed tomography was seen, raising concern for an arterial injury. A computed tomography angiography was performed subsequently revealing a transection of the internal carotid artery. This type of injury is highly lethal, and its management relies on urgent surgical intervention, and endovascular treatment, with the purpose of controlling the hemorrhage.

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