A Swelling of the Right Neck and Sudden Death

Neumann, Thomas; Bornkessel, Anja; Pfleiderer, Stefan O.R.; Hein, Gert; Isenmann, Stefan; Wolf, Günter; Terborg, C.

doi:10.1161/circulationaha.105.583940

Cited by 1 publication

(3 citation statements)

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“…Duplex sonography of the right carotid artery showed spontaneous echo contrast with slow, ineffective orthograde blood propulsions in accordance with severely decreased blood flow velocity as detected by Doppler sonography. A floating thrombus which might have mimicked this sonographic picture was excluded by DSA [6]. Similar to our findings, spontaneous echo contrast might be linked to low flow rates as well as elevated fibrinogen [9].…”

supporting

confidence: 85%

“…After surgical removal of the right carotid aneurysm and initiation of glucocorticoid therapy, the patient suddenly died two months later from a massive pericardial tamponade due to a ruptured coronary artery aneurysm as revealed by post-mortem examination. Histological examinations proved a mononuclear panarteritis involving the aorta, the large aortic branches as well as the pulmonary arteries, consistent with Takayasu's arteritis [6].…”

Section: Case Report !mentioning

confidence: 76%

“…Medical therapy comprises immunosuppression with glucocorticosteroids and/ or cytotoxic agents, and surgical treatment of stenoses or aneurysms may be required [22]. In our patient, unfortunately, the diagnosis was not confirmed before autopsy showed signs of panarteritis with granulocytes, lymphocytes, mononuclear cells and giant cells, but no granulomas [6].…”

mentioning

confidence: 70%

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Aneurysm of the Extracranial Carotid Artery with Spontaneous Echo Contrast Revealed by Duplex Sonography

Terborg

Brodhun²,

Joachimski³

et al. 2007

Ultraschall in Med

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A 56-year old male patient without cerebrovascular disease or risk factors presented with a painless, pulsatile right-sided cervical swelling. Ultrasonography showed a large aneurysm of the right common and internal carotid artery with homogeneous thickening of the vessel wall as well as a parietal thrombus and a dilation of the left common and internal carotid artery with markedly reduced blood flow velocities. In the enlarged lumen of the right internal carotid artery spontaneous echo contrast was apparent with slow, ineffective but orthograde blood flow motions. Ensuing diagnostic procedures revealed multiple aneurysms involving the aorta and its branches. Despite surgical removal of the aneurysm and glucocorticoid therapy, the patient died from a ruptured aneurysm of a coronary artery a few weeks later. Post-mortem examination showed panarteritis consistent with Takayasu's disease. Spontaneous echo contrast is a frequent echocardiographic finding in patients with atrial fibrillation and mitral stenosis, indicating decreased blood flow. This is associated with an increased risk of embolism. In our patient, spontaneous echo contrast indicated severely disturbed haemodynamics due to a large aneurysm of the carotid artery. In the rare case of multiple aneurysms, differential diagnosis should include dissections, infections, and connective tissue diseases. Takayasu's arteritis, however, should also be considered, which usually presents with stenoses, but may be associated with multiple aneurysms of the aorta or its branches. If the diagnostic criteria are present, immunosuppressive treatment should be initiated.

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supporting

confidence: 85%

Section: Case Report !mentioning

confidence: 76%