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Click A 74-year-old man with a persistent primitive hypoglossal artery (PPHA) who underwent excision of the right carotid mycotic aneurysm with an end-to-end anastomosis using an inter-positional homograft.

TECHNIQUE: Siemens Avanto MRI scanner. Magnetic strength = 1.5 Tesla. No intravenous contrast was administered. ADC sequence in the axial plane. TR = 3500 ms. TE = 90 ms. Slice thickness = 5mm.

FINDINGS: ADC reveals hypo-intense foci in the pons, right corona radiata, right occipital lobe and bilateral cerebellar hemispheres representing restricted diffusion. These are compatible with acute infarctions in the territories supplied by the right middle cerebral artery and posterior circulation.


Click A 74-year-old man with a persistent primitive hypoglossal artery (PPHA) who underwent excision of the right carotid mycotic aneurysm with an end-to-end anastomosis using an inter-positional homograft.

TECHNIQUE: Siemens Avanto MRI scanner. Magnetic strength = 1.5 Tesla. No intravenous contrast was administered. DWI sequence in the axial plane. TR = 3500 ms. TE = 89 ms. Slice thickness = 5mm.

FINDINGS: DWI reveals hyper-intense foci in the pons, right corona radiata, right occipital lobe and bilateral cerebellar hemispheres representing restricted diffusion. These are compatible with acute infarctions in the territories supplied by the right middle cerebral artery and posterior circulation.


Click A 74-year-old man with a persistent primitive hypoglossal artery (PPHA) who underwent excision of the right carotid mycotic aneurysm with an end-to-end anastomosis using an inter-positional homograft.

TECHNIQUE: Siemens Avanto MRI scanner. Magnetic strength = 1.5 Tesla. No intravenous contrast was administered. FLAIR sequence in the axial plane. TR = 6000 ms. TE = 2020ms TI = 134 ms. Slice thickness = 5mm.

FINDINGS: FLAIR sequence reveals hyper-intense foci in the pons, right corona radiata, right occipital lobe and bilateral cerebellar hemispheres representing oedema. These are related to acute infarctions in the territories supplied by the right middle cerebral artery and posterior circulation.


Click A 74-year-old man with a persistent primitive hypoglossal artery (PPHA) who underwent excision of the right carotid mycotic aneurysm with an end-to-end anastomosis using an inter-positional homograft.
TECHNIQUE: Siemens Avanto MRI scanner. Magnetic strength = 1.5 Tesla. No intravenous contrast was administered. MRA Rotate. TR 24 ms. TE = 7 ms.
FINDINGS: MRA Rotate demonstrates decreased flow signal in the right ICA as well as the right persistent hypoglossal artery.


Click A 74-year-old man with a persistent primitive hypoglossal artery (PPHA) who underwent excision of the right carotid mycotic aneurysm with an end-to-end anastomosis using an inter-positional homograft.
TECHNIQUE: Siemens Avanto MRI scanner. Magnetic strength = 1.5 Tesla. No intravenous contrast was administered. MRA Tumble. TR 24 ms. TE = 7 ms.
FINDINGS: MRA Tumble demonstrates decreased flow signal in the right ICA as well as the right persistent hypoglossal artery.


Click A 74-year-old man with a persistent primitive hypoglossal artery (PPHA) who underwent excision of the right carotid mycotic aneurysm with an end-to-end anastomosis using an inter-positional homograft.
TECHNIQUE: Siemens Avanto MRI scanner. Magnetic strength = 1.5 Tesla. No intravenous contrast was administered. Time-of-Flight magnetic resonance angiography (TOF MRA) sequence in the axial plane. TR = 24 ms. TE = 7 ms. Slice thickness = 0.6 mm.
FINDINGS: TOF MRA in the axial plane demonstrates decreased flow signal in the right persistent hypoglossal artery and right internal carotid artery.


Click A 74-year-old man with a persistent primitive hypoglossal artery (PPHA) who underwent excision of the right carotid mycotic aneurysm with an end-to-end anastomosis using an inter-positional homograft.
TECHNIQUE: Siemens Avanto MRI scanner. Magnetic strength = 1.5 Tesla. No intravenous contrast was administered. T2 TSE BLADE sequence in the axial plane. TR = 4174.9 ms. TE = 94 ms. Slice thickness = 5mm.
FINDINGS: T2 TSE BLADE sequence reveals hyper-intense foci in the pons, right corona radiata, right occipital lobe and bilateral cerebellar hemispheres representing oedema. These are related to acute infarctions in the territories supplied by the right middle cerebral artery and posterior circulation.


Click A 74-year-old man with a persistent primitive hypoglossal artery (PPHA) who underwent excision of the right carotid mycotic aneurysm with an end-to-end anastomosis using an inter-positional homograft.
TECHNIQUE: Siemens Avanto MRI scanner. Magnetic strength = 1.5 Tesla. No intravenous contrast was administered. T1 coronal MPR. TR = 1300 ms. TE = 600 ms. Slice thickness = 1mm.
FINDINGS: Scattered T1W hypointensities are noted in the pons, right corona radiata, right occipital lobe and bilateral cerebellar hemispheres which appear hyperintense on the T2W and FLAIR sequences and show restricted diffusion, representing acute infarctions in the territories supplied by the right middle cerebral artery and posterior circulation.


Click CT of a 74-year-old man with a persistent primitive hypoglossal artery (PPHA) and an ipsilateral carotid mycotic aneurysm.

TECHNIQUE: Philips iCT 256 CT scanner. Contrast-enhanced CT circle of Willis in the arterial phase in the axial plane. Tube voltage = 120 kV. Tube current = 399 mA. Slice thickness = 3 mm. A total of 60 mls of Omnipaque 350 was administered intravenously.

FINDINGS: Computed tomography angiogram (CTA) of the neck reveals a 2.8 x 2.5 cm large saccular mycotic aneurysm arising from the proximal extra-cranial right internal carotid artery (ICA) just distal to the carotid bifurcation. The PPHA arises from the right cervical ICA distal to the aneurysm as it anastomoses with the basilar artery after it courses through the right hypoglossal canal.


Click CT of a 74-year-old man with a persistent primitive hypoglossal artery (PPHA) and an ipsilateral carotid mycotic aneurysm.

TECHNIQUE: Philips iCT 256 CT scanner. Contrast-enhanced CT circle of Willis in the arterial phase in the axial plane with Maximum Intensity Projection (MIP) Tube voltage = 120 kV. Tube current = 399 mA. Slice thickness = 15 mm. A total of 60 mls of Omnipaque 350 was administered intravenously.

FINDINGS: Computed tomography angiogram (CTA) of the neck reveals a 2.8 x 2.5 cm large saccular mycotic aneurysm arising from the proximal extra-cranial right internal carotid artery (ICA) just distal to the carotid bifurcation. The PPHA arises from the right cervical ICA distal to the aneurysm as it anastomoses with the basilar artery after it courses through the right hypoglossal canal.


Click CT of a 74-year-old man with a persistent primitive hypoglossal artery (PPHA) and an ipsilateral carotid mycotic aneurysm.

TECHNIQUE: Philips iCT 256 CT scanner. Contrast-enhanced CT Circle of Willis in the arterial phase and in the coronal plane with Maximum Intensity Projection (MIP) Tube voltage = 120 kV. Tube current = 399 mA. Slice thickness = 15 mm. A total of 60 mls of Omnipaque 350 was administered intravenously.

FINDINGS: Computed tomography angiogram (CTA) reveals a 2.8 x 2.5 cm large saccular mycotic aneurysm arising from the proximal extra-cranial right internal carotid artery (ICA) just distal to the carotid bifurcation. The PPHA arises from the right cervical ICA distal to the aneurysm as it anastomoses with the basilar artery after it courses through the right hypoglossal canal.


Click CT of a 74-year-old man with a persistent primitive hypoglossal artery (PPHA) and an ipsilateral carotid mycotic aneurysm.

TECHNIQUE: Philips iCT 256 CT scanner. Contrast-enhanced CT carotid angiogram in the arterial phase and in the coronal plane with Maximum Intensity Projection (MIP) Tube voltage = 120 kV. Tube current = 399 mA. Slice thickness = 15 mm. A total of 60 mls of Omnipaque 350 was administered intravenously.

FINDINGS: Computed tomography angiogram (CTA) reveals a 2.8 x 2.5 cm large saccular mycotic aneurysm arising from the proximal extra-cranial right internal carotid artery (ICA) just distal to the carotid bifurcation. The PPHA arises from the right cervical ICA distal to the aneurysm as it anastomoses with the basilar artery after it courses through the right hypoglossal canal.


Click CT of a 74-year-old man with a persistent primitive hypoglossal artery (PPHA) and an ipsilateral carotid mycotic aneurysm.

TECHNIQUE: Philips iCT 256 CT scanner. Contrast-enhanced CT Circle of Willis in the arterial phase and in the sagittal plane with Maximum Intensity Projection (MIP) Tube voltage = 120 kV. Tube current = 399 mA. Slice thickness = 15 mm. A total of 60 mls of Omnipaque 350 was administered intravenously.

FINDINGS: Computed tomography angiogram (CTA) reveals a 2.8 x 2.5 cm large saccular mycotic aneurysm arising from the proximal extra-cranial right internal carotid artery (ICA) just distal to the carotid bifurcation. The PPHA arises from the right cervical ICA distal to the aneurysm as it anastomoses with the basilar artery after it courses through the right hypoglossal canal.


Click CT of a 74-year-old man with a persistent primitive hypoglossal artery (PPHA) and an ipsilateral carotid mycotic aneurysm.

TECHNIQUE: Philips iCT 256 CT scanner. Contrast-enhanced CT carotid angiogram in the arterial phase and in the sagittal plane with Maximum Intensity Projection (MIP) Tube voltage = 120 kV. Tube current = 399 mA. Slice thickness = 15 mm. A total of 60 mls of Omnipaque 350 was administered intravenously.

FINDINGS: Computed tomography angiogram (CTA) reveals a 2.8 x 2.5 cm large saccular mycotic aneurysm arising from the proximal extra-cranial right internal carotid artery (ICA) just distal to the carotid bifurcation. The PPHA arises from the right cervical ICA distal to the aneurysm as it anastomoses with the basilar artery after it courses through the right hypoglossal canal.


Click CT Carotid Angiogram with Volume Rendered Technique (VRT) of a 74-year-old man with a persistent primitive hypoglossal artery (PPHA) and an ipsilateral carotid mycotic aneurysm.

TECHNIQUE: Philips iCT 256 CT scanner. Tube voltage = 120 kV. Tube current = 399 mA. A total of 60 mls of Omnipaque 350 was administered intravenously.

FINDINGS: Computed tomography angiogram (CTA) reveals a 2.8 x 2.5 cm large saccular mycotic aneurysm arising from the proximal extra-cranial right internal carotid artery (ICA) just distal to the carotid bifurcation. The PPHA arises from the right cervical ICA distal to the aneurysm as it anastomoses with the basilar artery after it courses through the right hypoglossal canal.


Click CT Circle of Willis with Volume Rendered Technique (VRT) of a 74-year-old man with a persistent primitive hypoglossal artery (PPHA) and an ipsilateral carotid mycotic aneurysm.

TECHNIQUE: Philips iCT 256 CT scanner. Tube voltage = 120 kV. Tube current = 399 mA. A total of 60 mls of Omnipaque 350 was administered intravenously.

FINDINGS: Computed tomography angiogram (CTA) reveals a 2.8 x 2.5 cm large saccular mycotic aneurysm arising from the proximal extra-cranial right internal carotid artery (ICA) just distal to the carotid bifurcation. The PPHA arises from the right cervical ICA distal to the aneurysm as it anastomoses with the basilar artery after it courses through the right hypoglossal canal.


Click CT of a 74-year-old man with a persistent primitive hypoglossal artery (PPHA) and an ipsilateral carotid mycotic aneurysm who underwent excision of the mycotic aneurysm.

TECHNIQUE: Philips iCT 256 CT scanner. Contrast-enhanced CT Angiogram of the neck in the arterial phase with maximum intensity projection (MIP) in the coronal plane. Tube voltage = 120 kV. Tube current = 399 mA. Slice thickness = 15 mm. A total of 60 mls of Omnipaque 350 was administered intravenously.

FINDINGS:

There is interval excision of the right carotid mycotic aneurysm with an end-to-end anastomosis and interpositional homograft. There is decreased flow across the right internal carotid artery homograft and its distal branches. The right hypoglossal artery is not opacified and is likely occluded. The basilar artery is supplied by small reconstituted flow from collaterals.
A nasogastric tube and bilateral pleural effusions are noted.


Click CT of a 74-year-old man with a persistent primitive hypoglossal artery (PPHA) and an ipsilateral carotid mycotic aneurysm who underwent excision of the mycotic aneurysm.

TECHNIQUE: Philips iCT 256 CT scanner. Contrast-enhanced CT Angiogram of the circle of Willis in the arterial phase with volume rendered technique (VRT). Tube voltage = 120 kV. Tube current = 399 mA. Slice thickness = 15 mm. A total of 60 mls of Omnipaque 350 was administered intravenously.

FINDINGS:

Interval excision of the right carotid mycotic aneurysm is noted with an end-to-end anastomosis and interpositional homograft. There is reduced flow across the right ICA homograft and its distal branch. The right hypoglossal artery is not opacified and likely occluded. The basilar artery is supplied by small reconstituted flow from collaterals.