case_images: PMC11380808_01
case_images: (a) Head CT: a massive left subcutaneous hematoma on admission. (b) AP and (c) lateral views of the early arterial phase external carotid artery (ECA) digital subtraction angiography (DSA): poorly contrasted distal left STA due to compression by hematoma (black arrow). (d) The lateral view of the late arterial phase ECA DSA: minor extravasation near the contusion site (white arrow).
case_images: SNI-15-289-g001.jpg
case_images: PMC11380808_01_SNI-15-289-g001.jpg
case_images: F1
case_images: Head computed tomography (CT) showed a marked subcutaneous hematoma on the left [Figure 1a]. STA due to compression by hematoma in the early arterial phase of the left external carotid artery (ECA) on admission [Figure 1b and c] and minor extravasation near the contusion site in a late arterial phase [Figure 1d]. Since the diameter of the vessel involved in the extravasation was too small for microcatheter navigation, and the hematoma did not enlarge over time, we expected it to resolve spontaneously.
case_images: (a) Axial computed tomography. (b) Anterior- posterior view of the left external carotid artery (ECA) digital subtraction angiography (DSA): string sign of the left STA (black arrow), the dilated vein (white arrows), and the vein (bold arrows) draining via the arteriovenous fistula (dotted arrow). (c) Lateral view of the left ECA DSA: the dilated vein (white arrows) and the vein (bold arrows) draining via the arteriovenous fistula.
case_images: SNI-15-289-g002.jpg
case_images: PMC11380808_01_SNI-15-289-g002.jpg
case_images: F2
case_images: Head CT revealed left eye deformation due to compression by the enlarging hematoma [Figure 2a]. The angiography showed a string sign in the left proximal STA, suggesting arterial dissection [Figure 2b]. It was connected to a remarkably dilated vein (varix) draining to the facial and external jugular veins through the fistula [Figure 2b and c].
case_images: (a) Anterior- posterior and (b) lateral views of the left external carotid artery (ECA) digital subtraction angiography (DSA) immediately after embolization. (c and d) Follow-up of DSA of the left ECA two months after the intervention.
case_images: SNI-15-289-g003.jpg
case_images: PMC11380808_01_SNI-15-289-g003.jpg
case_images: F3
case_images: As a result, the varix, AV shunt, and drainage veins were blocked [Figure 3a and b]. Two months later, follow-up angiography confirmed no vascular abnormality recurrence [Figure 3c and d].