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Circulation. 2000;102:e105

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(Circulation. 2000;102:e105.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Ultrasound Finding of a Mobile Atheroma in the Common Carotid Artery

Felix Schlachetzki, MD; Thilo Hoelscher, MD; Max Lange, MD; Piotr Kasprzak, MD

From the Departments of Neurology (F.S., T.H., M.L.) and Surgery (P.K.), University of Regensburg, Regensburg, Germany.

Correspondence to Felix Schlachetzki, MD, Department of Neurology, University of Regensburg, Universitaetsstr 84, 93053 Regensburg, Germany. E-mail felix.schlachetzki{at}klinik.uni-regensburg.de

A50-year-old woman was admitted for a mild left hemispheric stroke with right-sided hemiparesis and motor aphasia. In the previous 3 months, she had suffered from several transient ischemic attacks in all cerebrovascular territories, as revealed by MRI, which was suggestive of recurrent cardiac embolization. Transesophageal echocardiography revealed an atrial septum aneurysm; spiral computed tomography of the neck demonstrated a thrombus adjacent to the wall of the left common carotid artery (CCA), close to a large thyroid nodule (Figure 1Down). Ultrasound examination demonstrated a 4x6x2 cm thrombus, with the distal end floating freely in the blood stream (Figures 2Down and 3Down; movie sequences of this finding are available on http://circ.ahajournals.org). Because of this finding, immediate carotid thromboendarterectomy to prevent thrombus fragmentation with subsequent embolization and major left hemispheric stroke was performed. Histological examination of the resected specimen revealed degenerative changes and mild inflammation of the intima. The patient recovered well from the stroke and the surgery.



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  		Figure 1. Spiral computed tomography scan of the neck. Arrow points at thrombus adjacent to medial vessel on left CCA. 1 indicates jugular vein; 2, enlarged goiter.



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  		Figure 2. Ultrasound B-mode image of CCA (axial scan). Image plane is within free-floating portion of thrombus.



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  		Figure 3. Ultrasound B-mode image of CCA (longitudinal scan). Arrow marks fragile thrombus cleft.

Footnotes

Animated versions of Figures 2Up and 3Up can be found at http://www.circulation.org

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.





This Article
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Right arrow Articles by Schlachetzki, F.
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Right arrow Articles by Schlachetzki, F.
Right arrow Articles by Kasprzak, P.
Related Collections
Right arrow Arterial thrombosis
Right arrow Embolic stroke
Right arrow Emergency treatment of Stroke
Right arrow Doppler ultrasound, Transcranial Doppler etc.
Right arrow Carotid endarterectomy

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