Imaging description

Blunt and penetrating neck trauma can result in significant morbidity and mortality. While unstable patients, particularly those with penetrating injuries, are often directly taken for surgical exploration, relatively stable patients are evaluated with imaging for prompt diagnosis and treatment. Vascular injuries are significantly more frequent with penetrating injuries than with blunt neck trauma. Carotid artery is more frequently involved in penetrating injury. On the other hand, vertebral artery involvement is more common with blunt trauma.

The diagnosis of vascular injury can be made with either CTA or MRI/MRA, but CT is generally the technique of choice for initial evaluation of patients with neck and cervical spine injuries. This is especially relevant in patients with penetrating injuries, who may be suspected of having embedded metal fragments in the soft tissues (Fig. 85.1). Regardless of the mechanism of injury, similar imaging manifestations are seen on cross-sectional studies [1]. These include vascular dissections, dissecting aneurysms, arterial stenosis or occlusion, arteriovenous fistula, or frank extravasation (Figs. 85.1, 85.2, 85.3).