title: Delayed presentation of a carotid pseudoaneurysm following penetrating neck trauma.
abstract: OBJECTIVE
  Penetrating carotid trauma in a hemodynamically stable patient invariably presents with a pseudoaneurysm on initial imaging. Although extremely rare, delayed pseudoaneurysm formation has been reported. The purpose of this paper is to define this rare entity and propose a diagnostic and treatment plan.
  
  
  METHODS
  We present a case of delayed presentation of carotid pseudoaneurysm following penetrating neck trauma. A systematic review of the literature was performed.
  
  
  RESULTS
  A 21-year-old male presents to the trauma center after sustaining a gunshot wound to the left upper back resulting in a zone 2 hematoma and pneumothorax. Bullet fragment artifact interfered with computed tomography. Carotid angiogram was normal. The patient was discharged after 3 days. He returned to the Emergency Department 3 months later with a painful pulsatile hematoma. Computed tomography angiogram revealed a 6-cm pseudoaneurysm arising from the proximal left internal carotid artery (ICA). A left common carotid artery (CCA) to ICA bypass with reversed great saphenous vein was performed. The patient's post-operative course was uneventful, neurologic deficits improved, and he was discharged.
  
  
  CONCLUSIONS
  Delayed presentation of traumatic pseudoaneurysms has been reported, although usually these cases are iatrogenic access complications in extremities. While endovascular therapies are first line for zone 1 and 3 vascular injuries, management of zone 2 injuries is still controversial. This patient was treated with a bypass due to the need to evacuate the hematoma that was exerting a mass effect in the neck.
authors.affiliation: Department of Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Alfawaz
authors.affiliation: Department of Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA.
authors.forename: Xiaoyi
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kénel-Pierre
authors.affiliation: Department of Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Rey
authors.affiliation: Department of Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA.
authors.forename: Handel
authors.initials: H
authors.lastname: Robinson
keywords: Carotid trauma; delayed presentation; penetrating trauma; pseudoaneurysm