PMC9704849_01
Maximum intensity projection image of pre-(A) and postoperative (B) magnetic resonance angiography. Intraoperative view of the exposed carotid artery (C).
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Another magnetic resonance imaging (MRI) revealed progressive stenosis in the right ICA despite optimal medical treatment with clopidogrel sulfate (75 mg/day) and pitavastatin calcium (2 mg/day) (Fig. 1A), which caused transient visual dysfunction in his left eye when his blood pressure was low. ICA occlusion. CEA was successfully performed under general anesthesia using a vascular shunt, and the stenotic lesion was successfully removed (Fig. 1B). Intraoperatively, the influence of previous radiation therapy, such as scar formation, tissue adhesion, and vulnerability of the arterial wall, was not apparent objectively (Fig. 1C).
Axial image of the surgical site by computed tomography 1 (A) and 7 days (B) after carotid endarterectomy, when the abscess was detected (C).
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A computed tomography (CT) scan 7 days after surgery revealed a small amount of fluid in the carotid space that was not apparent 1 day after surgery (Fig. 2A, B), which was thought to be exudate, and the patient was discharged. Physical examination revealed no remarkable findings, including signs of wound infection or fever; however, CT and carotid duplex ultrasound revealed increased fluid collection in the right pericarotid space (Figs. 2C and 3A).
The pericarotid abscess was depicted as a heterogeneous echoic area in the carotid duplex ultrasound (A) with high intensity on diffusion-weighted image (B). Axial image of the surgical site by computed tomography after surgical drainage of the abscess (C) and at the time of discharge (D).
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Physical examination revealed no remarkable findings, including signs of wound infection or fever; however, CT and carotid duplex ultrasound revealed increased fluid collection in the right pericarotid space (Figs. 2C and 3A). Additionally, MRI was performed for qualitative evaluation of the fluid on the following day, and the findings were suggestive of pericarotid cervical abscess because of the high intensity on diffusion-weighted imaging (DWI) (Fig. 3B). The patient underwent surgical drainage under local anesthesia (Fig. 3C, D), and the antibiotics were changed to sulbactam/ampicillin + teicoplanin.