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Dissection of the carotid artery as a cause of fatal airway obstruction
  1. L Lacey,
  2. N Dabbas,
  3. R Saker,
  4. C Blakeley
  1. Emergency Department, Mayday University Hospital, Croydon, London, UK
  1. Correspondence to:
 Dr C Blakeley
 Emergency Department, Mayday University Hospital, London Road, Croydon, London CR7 7YE, UK; christopher.blakeley{at}mayday.nhs.uk

Abstract

Carotid artery dissection is a rare entity, and most cases are attributable to causative factors, which include trauma and local malignancy. The vast majority of dissections present with cerebral infarct; those few that present with local mass effect and respiratory compromise may deteriorate rapidly, requiring urgent resuscitation and consideration of endotracheal intubation, which is often dangerous and/or impossible. The case of a spontaneous internal carotid artery dissection in an otherwise healthy young man, leading to gross mass effect and eventual fatal airway obstruction, is presented here. The need for a high index of suspicion for cervical vascular injury in cases of neck injury (even trivial), known head and neck malignancy/irradiation, or coagulopathy is highlighted. Patients presenting with unilateral neck swelling and symptoms related to mass effect must be assumed to have progressive airway obstruction, and difficult intubation should be anticipated.

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Footnotes

  • Funding: None.

  • Competing interests: None.

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