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cv > Unit 13. Uncommon Carotid Pathology Documentation > Flashcards

Unit 13. Uncommon Carotid Pathology Documentation Flashcards

1
Q

What are some cerebrovascular diseases?

A
  • Athersclerosis
  • Tortuosity
  • Dissection
  • Carotid body tumor
  • Fibromuscular dysplasia
  • Thrombosis
  • Aneurysm/pseudoaneurysm
  • Subclavian steal.
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2
Q

What are the symptoms of tortuosity/kinking?

A

Usually asymptomatic.

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3
Q

What can a kink potentially cause?

A

May cause a TIA or stroke upon moving the position of the head.

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4
Q

What are the risk factors for tortuosity/kinking?

A
  • Congenital
  • Women
  • Elderly.
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5
Q

What could a commonly tortuous proximal CCA be mistaken for?

A

An aneurysm b/c the artery gets very close to the skin.

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6
Q

Which portion of the ICA is commonly tortuous?

A

The distal ICA

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7
Q

How can you document tortuosity?

A
  • Color images
  • Manipulate probe to get most of the vessel in one plane
  • Adjust color scale so that only vertical parts of the vessels have aliasing if possible.
  • Use power control to show course of vessels.
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8
Q

What is a dissection?

A

It is a sudden tear in the intimal wall, separating the layers.

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9
Q

Where does a dissection usually occur?

A

Usually intima is separated from media, but at times both intima and media are separated from adventitia.

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10
Q

What symptoms are associated with a dissection?

A

Pain and sometimes stroke symptoms.

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11
Q

What is the usual cause of a dissection?

A

Trauma

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12
Q

Where does a dissection usually originate?

A

In the aorta & it may extend to the CCA

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13
Q

What can be caused by a dissection?

A

A smooth, long stenosis.

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14
Q

When should you suspect a dissection?

A

If no evidence of athersclerosis but abnormal scan with trauma.

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15
Q

How should you documet a dissection?

A
  • MUST demonstrate a white line (loose intima) in the vessel in B-mode in long and trans views.
  • Show a color view of the flow on each side of the dissection. One side may be fully thrombosed woth no color.
  • MUST show two doppler waveforms, one on each side of the dissection. Each waveform should be different from eachother.
  • TRY to show the beginning and end of the dissection, but this is not always possible.
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16
Q

What does FMD usually involve?

A

It iinvolves abnormalities in the medial wall of the artery.

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17
Q

Who is usually at risk for FMD?

A

Women over the age of 40

18
Q

What is the result of FMD?

A

Narrowings followed by medial thinning in the artery.

19
Q

What does FMD look like and where does it typically occur?

A
  • A string of beads appearance.
  • Usually in the distal ICA
  • Renal and carotid arteries are affected.
20
Q

When is FMD suspected?

A

After no sign of athersclerosis in the proximal ICA, suddenly an area of high turbulent flow encountered in the mid/distal ICA

21
Q

How should you document FMD?

A
  • Must show marked turbulence in the mid/distal ICA.
    • There might be midly or moderately high psv as well.
    • Try t get a color image of the “string of beads”
    • Try to get a B-mode image of the string as well.
22
Q

Where do carotid body tumors occur?

A

They occur at the carotid body between the internal and external carotid arteries.

23
Q

What are the characteristics of a carotid body tumor?

A
  • Slow growing and possibly malignant.
  • Highly vascular
24
Q

Are carotid body tumors unilateral or bilateral?

A

Usually unilateral.

25
Q

What is the carotid body tumor fed by?

A

External carotid branches.

26
Q

What things do you want to ensure is captured in your images while scanning a carotid body tumor?

A
  1. Be sure to get an imagr of the splaying of the ICA and ECA
  2. Be sure to measure in trans and long.
  3. Be sure to demonstrate if tumor encircles either the ICA or ECA or both.
  4. Be sure to get an image of the ECA branches feeding the mass.
27
Q

What is the type I carotid body tumor classification?

A

Small with minimal attachment to artery,

28
Q

What is type 2 carotid body classification?

A

Slightly larger, partially encircles vessels.

29
Q

What is type 3 carotid body tumor classification?

A

It iss the largest and it incorporates both arteries and vagus nerve.

30
Q

How should you document a carotid body tumor?

A
  • Demonstrate splaying of ICA/ECA in one color image if possible.
  • Demonstrate the tumor mass in trans and long with measurements of its size.
  • Clearly show the mass location relative to the ICA and ECA.
  • Demonstrate the flow in the mass and show it connect to an ECA branch if possible.
31
Q

What is an aneurysm?

A

It is a dilation of the artery wall.

32
Q

Are common are aneurysms?

A

Extremely rare.

33
Q

What are pseudoaneurysms?

A

It is a hole in the artery that results in a fluid mass with flow in and out of the artery and mass.

34
Q

In order for a pathology to be considered a pseudoaneurysm, what must there be?

A

A reason.

ie. needle

35
Q

How common are pseudoaneurysms?

A

Extremely rare.

36
Q

How should you document an aneurysm?

A
  • Be sure to measure the diameter of the aneurysm a its widest point in long and transverse.
  • Keep measurements perpendicular to flow, even if the line is not directly AP
  • Be sure to measure the diameter of the normal vessel both proximal and distal to the aneurysmal area for comparison.
37
Q

How should you document a pseudoaneurysm?

A
  • Measure mass in long and transverse
  • COlor image of flow/thrombus in PA
  • Color image with doppler PSV and waveform in the PA neck.
  • Color image to show its connection to a native vessel.
38
Q

When is it appropriate to label something as a thombus in the carotid?

A

It MUST be moving to truly distinguish thrombus from plaque.

39
Q

What could cause suspicion of thrombus?

A

Unusual echogenicity.

40
Q

How should you document a thrombus in a carotid?

A
  • Take a trans view in B-mode
  • Take a clip in long and trans view demonstrating motion.
  • Show beginning and end of thrombus if possible.

cv (16 decks)

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