case_images: PMC11221826_01
case_images: Neck B-mode ultrasound. (A) Paraxial view using a high-resolution multifrequency linear probe (bandwidth 3-12 MHz). The fish bone passes from the soft tissue posterior to the right lobe of the thyroid to the common carotid artery, where it forms a pseudoaneurysm at the site of entry. A foreign body is seen as a hyper-echoic linear structure within the common carotid artery. Ultrasound machine: Logiq S-8, General Electric, Milwaukee. (B and C) Axial ultrasound view in B-mode (B) and B-mode color Doppler (C) showing a pseudoaneurysm on the medial side of the right common carotid artery. T: thyroid gland; Fb: foreign body; Ps: pseudoaneurysm; C.a.: common carotid artery.
case_images: aaem-12-e45-g001.jpg
case_images: PMC11221826_01_aaem-12-e45-g001.jpg
case_images: F1
case_images: FB coursing from the right thyroid lobe and running obliquely, with the tip of the FB abutting the right common carotid artery (Figure 1A). Immediately superior to the FB entry point, turbulent forward and backward flow caused a characteristic "yin-yang" sign on color flow and a "to and fro" pattern on pulsed Doppler, indicating a pulsating pseudoaneurysm (Figure 1B and C).
case_images: (A) Cervical computed tomography (CT) scan without contrast. Axial basal view of a CT scan (64 slices Ingenuity, Philips, Eindhoven, Netherlands) before administration of contrast medium. A 3-cm hyperdense fishbone can be observed on the right side, migrated into the soft tissues and right neck vascular bundles. Without administration of iodinate contrast medium, it was not possible to assess which vessel had been involved. Abbreviations: T: Thyroid gland; F.b.: foreign body. (B) Contrast-enhanced computed tomography: arterial and vascular phase. Axial view of a contrast-enhanced CT scan (64 slices Ingenuity, Philips, Eindhoven, Netherlands) in the arterial and vascular phases; maximum intensity projection (MIP) technique with 10 cm thickness. A 3-cm hyperdense fishbone can be observed with the lateral extremity in the common carotid artery, the medial extremity in the neck soft tissue (behind the right thyroid lobe), and the pseudoaneurysm on the medial side of the carotid artery at the point at which the fishbone enters the vessel. (C) Contrast-enhanced CT scan in the coronal plane in the arterial phase. Contrast-enhanced CT scan in the arterial, vascular phase (CT 64 slices; Ingenuity, Philips) after intravenous injection of 80 ml of the nonionic soluble water Iopamiro 370 mg/ml (Bracco, Milan, Italy). A 3-cm hyperdense fish bone can be observed with the lateral extremity in the common carotid artery and the medial extremity in the neck soft tissue. A pseudoaneurysm on the medial side of the carotid artery at the point of fish bone entrance is observed. (A) A coronal view of the right carotid artery was obtained using the MIP technique with a thickness of 10 mm. (B) On the right side, the same CT arterial vascular phase scan was performed using the volume rendering (VR) technique to create a three-dimensional representation of the data. The carotid artery pseudoaneurysm and the fish bone with its medial extremity within the artery are well depicted. Fb: foreign body; Ps.: pseudoaneurysm; C.a.: common carotid artery.
case_images: aaem-12-e45-g002.jpg
case_images: PMC11221826_01_aaem-12-e45-g002.jpg
case_images: F2
case_images: FB (Figure 2 c). Furthermore, medially, there was a 3 cm hematoma in the adjacent soft tissues contiguous with the right thyroid lobe, with no evidence of active bleeding.
case_images: Intraoperative view of the neck dissection. (A) The Pruitt-Inahara F3  Carotid Shunt and the tract of the common carotid artery are visible. (B) Surgically removed accidentally ingested fish bone.
case_images: aaem-12-e45-g003.jpg
case_images: PMC11221826_01_aaem-12-e45-g003.jpg
case_images: F3
case_images: Healthy segments of the common and internal right carotid arteries were isolated, then, during clamping for less than one minute, a Pruitt-Inahara F3  Carotid Shunt was successfully positioned (Figure 3A). A 3-cm long fish bone (Figure 3B) with complete piercing of the right common carotid artery was successfully removed, hemostasis achieved, and the lacerated segment of the common carotid artery removed.