Delayed presentation of penetrating carotid injury: Two cases and a review of the literature

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Background Carotid injuries secondary to a penetrating mechanism of trauma can present immediately, weeks, or even years after the initial injury. Although uncommon, these injuries are associated with significant morbidity and mortality. We present two cases of delayed presentation of carotid injury after penetrating neck trauma, both of which were managed surgically. Case report A 57-year-old male presented with a symptomatic left facial artery pseudoaneurysm two weeks after sustaining a Zone III laceration at angle of mandible. He underwent successful left neck exploration and repair of pseudoaneurysm with complete resolution of his symptoms post-operatively. A 33-year-old female with a history of penetrating right neck trauma repaired primarily 10 years prior in Russia presented with new onset left upper extremity weakness and tingling. Outpatient diagnostic workup revealed a right common carotid aneurysm which was repaired with a polytetrafluoroethylene interposition graft. The patient was discharged without residual neurologic deficits. She represented several years later with neurologic symptoms and an occluded graft. She underwent successful ligation of her graft and was discharged with complete resolution of her symptoms. Conclusion Penetrating carotid injuries can manifest in an immediate or delayed fashion. Computerized tomographic angiography appears to be an appropriate diagnostic tool. Once diagnosed, either endovascular or surgical repair may be valid treatment options.

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