PMC3804144_01
Contrast-enhanced angiographic CT (CTA). (a) Contrast-enhanced CT angiography in axial view shows the large right cervical hematoma causing anterior displacement of the right thyroid lobe and slight tracheal deviation to the left. (b) CT angiography in coronal maximal intensity projection (MIP) reformation showing the classical "strings of beads" sign in the right ICA (black arrows), typical for FMD, the stent in the left ICA (black dashed arrows), and the coil in the paraophthalmic segment of the right ICA (black arrow). No active bleeding is seen.
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After consulting with vascular surgeons, a contrast CT angiography was performed (Figure 1), demonstrating a large right neck hematoma that has caused anterior displacement of the right thyroid lobe and tracheal deviation to the left. Nevertheless, the patient was transferred to the intensive care unit (ICU), and conventional angiography was performed (Figure 1) in an attempt to localize and control the source of the bleeding.
Angiography of the cervical arteries. Conventional angiography demonstrates typical "strings of beads" in the right ICA (black arrows) without active bleeding.
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Following the scan, the patient underwent a cerebral angiography and coiling of an aneurysm located in the paraophthalmic segment of the right ICA (see Figure 2).
The picture was taken on the second day of hospitalization: hematoma had spread to the upper chest reaching the right breast.
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Next morning, hoarseness has been noted, as well as an expansion of the hematoma to midchest and to the right areola (Figure 3).