Dissection of the carotid artery as a cause of fatal airway obstruction.
Carotid artery dissection is a rare entity, and most cases are attributable to causative factors, which include trauma and local malignancy. The vast majority of dissections present with cerebral infarct; those few that present with local mass effect and respiratory compromise may deteriorate rapidly, requiring urgent resuscitation and consideration of endotracheal intubation, which is often dangerous and/or impossible. The case of a spontaneous internal carotid artery dissection in an otherwise healthy young man, leading to gross mass effect and eventual fatal airway obstruction, is presented here. The need for a high index of suspicion for cervical vascular injury in cases of neck injury (even trivial), known head and neck malignancy/irradiation, or coagulopathy is highlighted. Patients presenting with unilateral neck swelling and symptoms related to mass effect must be assumed to have progressive airway obstruction, and difficult intubation should be anticipated.
Lacey
L
L
Emergency Department, Mayday University Hospital, Croydon, London, UK.
Dabbas
N
N
Saker
R
R
Blakeley
C
C
D000328:Adult; D000402:Airway Obstruction / Q000209:etiology* / Q000628:therapy; D020215:Carotid Artery, Internal, Dissection / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D011859:Radiography