Carotid artery laceration secondary to thyroid cartilage fracture: An unusual complication of blunt neck trauma

Abstract

C a r o t i d artery injury secondary to blunt neck trauma is much less common than carotid damage from penetrating neck injury.' Before 1978, 96 cases were reported.',' Since 1978, an additional 86 cases have been reported in the English-language literature. '.3-14 The clinical manifestations of carotid injury from blunt neck trauma can be subtle. In such situations, the clinician must have a high level of suspicion for a correct diagnosis to be made. This is especially true when a patient seeks treatment after an interval without symptoms. We report a unique mechanism of extracranial carotid injury from a blunt blow to the neck. This injury resulted in a fracture of the greater cornu of the thyroid cartilage and a subsequent transmural tear of the common carotid artery. CASE REPORTA 41-year-old man was admitted for progressive dysphagia. The patient reported that he had sustained a punch to the left jaw and neck approximately 1 week before admission.He denied dyspnea, hoarseness, hemoptysis, or hematemesis. He smoked 30 packs of cigarettes per year.Physical examination revealed an alert, well-nourished, middled-aged man in no distress. He had no fever and had a stable blood pressure of 130/70 mm Hg. There was no stridor or tachycardia. Ecchymosis and edema of the posterior pharyngeal wall were greater on the left side. Fiberoptic nasopharyngoscopy revealed bilaterally mobile vocal cords and a clear airway. There was bilateral neck fullness but no subcutaneous emphysema or discrete masses. There was no tenderness over the thyroid cartilage and no laryngeal crepitus. The carotid, facial, and superficial temporal artery pulses were full and symmetric. There were no bruits or thrills. Results of neurologic examination were normal.Soft-tissue radiographs of the neck showed a retropharyn-

An Enlarging Neck Mass

“…This case likely resulted from a type 1 BCI, resulting from a past, though unknown, trauma that caused the fracture of the thyroid cartilage. There are several reports in the literature of extracranial carotid artery pseudoaneurysm formation due to similar mechanisms as in this case, most involving facial fractures Interestingly, there is 1 report with an almost identical mechanism of injury, involving the formation of a common carotid pseudoaneurysm from a fragment of the thyroid greater cornu. In this case, a man presented with progressive dysphagia 1 week after being punched in the jaw.…”

Odynophagia Secondary to Variant Thyroid Cartilage Anatomy

“…Trauma may occur during endotracheal intubation or may be related to an external compression, such as strangulation, or an external blow [2]. The trauma can lead to serious consequences as described in a case report by Aviv et al [3]. In this case, the patient presented with progressive dysphagia one week following blunt trauma to the neck.…”

“…In the absence of other pathologic findings on physical examination or imaging, these symptoms have often been attributed to anatomic variants of thyroid cartilage anatomy [1][2][3][4]. A displaced superior cornu of the thyroid cartilage has been described as a cause of dysphagia and globus sensation [1,4].…”