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JSE Booth (The Scut Report) posted a DSA image of a critical Carotid stenosis yesterday.

Coincidentally, I had a patient for Carotid arterial Doppler ultrasonography yesterday who had similar critical Internal Carotid stenoses on both sides. Here are the pictures.

Colour Doppler US image of the right Common Carotid arterial bifurcation with a large eccentric fibrofatty plaque. Severe aliasing and turbulence are seen at the stenotic segment.

The Spectral Doppler trace shows extremely high systolic and diastolic velocities (PSV 450cm/s & EDV240cm/s) in the stenotic segment with turbulence.

Colour Doppler US image of the left Internal Carotid arterial origin with a large eccentric calcified plaque. Severe aliasing and turbulence are seen at the stenotic segment.

The Spectral Doppler trace shows extremely high systolic and diastolic velocities (PSV >500 cm/s with aliasing & EDV 260 cm/s) in the stenotic segment with turbulence.

After seeing JSE Booth’s post, I was curious as to whether this patient had bruits. I was not curious motivated enough to go check that myself. I did what all senior doctors do. Called up our Family Medicine residents and gave them a spot test ‘to go find something interesting in the general examination of that particular patient.’ One of them called back a little later and told me the patient had a palpable thrill and an audible bruit on the right side. There wasn’t anything noticeable on the left side.

Suggested reading:

EG Grant, CB Benson, GL Moneta, AV Alexandrov, JD Baker, EI Bluth et al. Carotid Artery Stenosis: Gray-Scale and Doppler US Diagnosis – Society of Radiologists in Ultrasound Consensus Conference. Radiology 2003: 229:340-346. [read the full text of the article here]

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