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Vascular Sonography > Uncommon pathology of the Carotid System > Flashcards

Uncommon pathology of the Carotid System Flashcards

1
Q

What pathology is known as the abnormal growth and development of the muscular layer of an artery wall with fibrosis and collagen deposition causing a localized series of stenoses?

A

Fibromuscular dysplasia

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2
Q

What are the other names for a carotid body tumour?

A
  1. Paraganglioma
  2. Chemodectoma
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3
Q

Where are carotid artery tumours located?

A

At the carotid bifurcation

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4
Q

What vessel is most commonly affected by tortuosity?

A

ICA

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5
Q

In the case of a tortuous vessel, where should you document doppler velocities?

A

Before, in, and beyond the curve/kink

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6
Q

What type of waveform may be seen if a tortuous vessel is producing a stenosis?

A

Tardus parvus in the case of a distal stenosis

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7
Q

What pathology is known as a separation of layers of an artery by a tear in the intima?

A

Arterial dissection

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8
Q

In what 3 clinical situation are dissections seen?

A
  1. Extension into the CCA from aortic dissection
  2. Trauma to the ICA
  3. From underlying disease such as FMD, arteritis, or defects in the vessel wall collagen
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9
Q

What is the hallmark appearance of an ICA dissection?

A
  1. Intramural hematoma
  2. Luminal narrowing or occlusion of true lumen
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10
Q

In a dissection, if blood exits the false lumen via a secondary tear PROXIMAL to the original tear, will flow appear antegrade or retrograde?

A

Retrograde

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11
Q

In a dissection, if blood exits the false lumen via a secondary tear DISTAL to the original tear, will flow appear antegrade or retrograde?

A

Antegrade

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12
Q

What is the MOST COMMON cause of stroke in young and middle aged individuals?

A

Dissection

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13
Q

Patient symptoms with an ICA dissection vs CCA dissection?

A
  1. ICA:
    - Unilateral pain of head, neck, and face
    - Partial Horner syndrome (ptosis: drooping of eyelid), miosis: constriction of the pupil)
    - Cerebral or retinal ischemia
  2. CCA: headaches and neck pain
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14
Q

In a dissection, where is the true lumen in relation to the false lumen?

A

True lumen is anterior to the false lumen

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15
Q

Where in the ICA are most cases of dissection?

A

Very superior and not identifiable on a carotid scan

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16
Q

What pathology contains abnormal growth of smooth muscle cells and fibrous tissue?

A

FMD

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17
Q

What is the most common sonographic presentation of FMD?

A

“String of beads” and dilation

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18
Q

What arteries are typically affected by FMD?

A

ICA and renal arteries

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19
Q

In what population does FMD usually occur?

A

Young females

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20
Q

What is the most common symptom of renal FMD?

A

Hypertension

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21
Q

What is the most common symptom of cerebrovascular FMD?

A

Headaches

22
Q

When a patient presents with symptoms of FMD, what artery is very crucial to try and image?

A

Distal ICA

23
Q

Where are carotid body tumour located?

A

Adventitia of the carotid bifurcation

24
Q

What type of cells do carotid body tumours (paraganglioma) arise from?

A

Chemoreceptor cells

25
Q

What does the carotid body control?

A

Blood pressure and pH

26
Q

SF of carotid body tumour?

A
  1. Hypoechoic mass between the ICA and ECA
  2. Highly vascular and are fed by branches off ECA
  3. Low-resistance waveform
27
Q

What arterial layers are affected in a carotid aneurysm?

A

All three layers

28
Q

Where are carotid aneurysms mostly found?

A

CCA and ICA bifurcation and are FUSIFORM

29
Q

What is the main cause for a carotid aneurysm to occur?

A

Atherosclerosis

30
Q

Patient presentation with a carotid aneurysm?

A

Non-tender, pulsatile mass

31
Q

What is the difference between a true aneurysm and a pseudoaneurysm?

A

True aneurysm - involves all three wall layers

Pseudoaneurysm - only involves intimal layer

32
Q

What usually causes a pseudoaneurysm?

A

Trauma

33
Q

What should be documented with a pseudoaneurysm?

A
  1. The PA itself
  2. The neck of the PA
  3. The feeding artery
  4. Measure outer size of the PA to include any thrombosed component
  5. Measure the width and length of the neck
34
Q

What kind of doppler flow pattern is seen with a pseudoaneurysm?

A

To and Fro flow in the neck of the PA

35
Q

What type of colour sign is seen in a pseudoaneurysm mass?

A

yin-yang sign

36
Q

What does RIAI stand for?

A

Radiation-Induced Arterial Injury

37
Q

What can be caused at the site of treatment with RIAI? What artery will this occur?

A

Atherosclerosis in the CCA which can cause stenosis

38
Q

The maximum area of stenosis in radiation-induced lesions tends to be located where?

A

Distal end of the stenotic area

39
Q

Are radiation induced or NON-radiation induced stenotic lesions longer?

A

Radiation induced - significantly longer

40
Q

What pathology is the inflammation of the artery wall?

A

Arteritis - may produce thickening, stenosis, and occlusion

41
Q

What are the two types of arteritis? What population are they most common?

A
  1. Takayasu’s - affect aortic arch in a specific order: Subclavian –> CCA –> Aorta –> renal arteries
    (most common in younger women)
  2. Giant cell arteritis - affects medium and large vessels - aortic arch, axillary, carotid
    (most common in elderly people)
42
Q

SF of takayasu’s arteritis?

A

Long, smooth, homogenous thickening of arterial walls

43
Q

What additional arteries are scanned with giant cell arteritis? (hint: higher in the head)

A

Common superficial temporal artery and it’s branches: Parietal and frontal branches

44
Q

What sonographic sign is seen with takayasu’s arteritis?

A

Macaroni sign in TRV - concentric and evenly distributed around vessel

45
Q

What is a common sonographic feature in the temporal artery that is indicative of temporal arteritis?

A

Echolucent halo around temporal artery

46
Q

What vessel layer do carotid body tumours arise in?

A

Adventitia

47
Q

What is the main cause of a carotid aneurysm?

A

Atherosclerosis

48
Q

For a scan ordered for giant cell arteritis, what artery MUST be looked at?

A

Superficial temporal artery (STA)

49
Q

When examining Takayasu’s arteritis, what vessel must you pay extra attention to?

A

Proximal CCA

50
Q

When examining Giant cell arteritis, what vessel should you make sure to assess?

A

Superficial temporal

Vascular Sonography (17 decks)

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