Thirion Jan C, Van Hoving Daniël J
Rural Health Services, Western Cape Government, Worcester.
Afr J Prim Health Care Fam Med. 2025 Jul 23;17(1):e1-e3. doi: 10.4102/phcfm.v17i1.4959.
Extracranial carotid artery aneurysms and pseudoaneurysms are rare, comprising less than 4% of all peripheral artery aneurysms. Rural primary health care facilities often face significant challenges because of limited access to formal imaging. Point-of-care ultrasound (PoCUS) has the potential to bridge this gap, accelerating timely diagnosis and management in remote settings.
A 19-year-old male presented to a rural primary health care clinic in the Western Cape of South Africa with a 3-week history of left-sided neck swelling and recent odynophagia. Physical examination revealed a firm, pulsatile mass with an audible bruit.
Formal imaging was unavailable for several months, delaying surgical advice. However, the clinic's newly procured mobile ultrasound allowed for PoCUS, which identified a pulsatile vascular lesion consistent with a carotid pseudoaneurysm. Computed tomography angiography confirmed the diagnosis, and the patient was referred for tertiary care where the lesion was repaired. He had vasculitis on histology and exhibited inconclusive features of a connective tissue disorder, but a definitive cause was not found. Despite multiple attempts, he could not be contacted for follow-up.
This case highlights how PoCUS can accelerate definitive management in resource-limited settings.Contribution: Point-of-care ultrasound is potentially an effective, cost-efficient diagnostic tool in rural healthcare settings but requires significant investment in equipment and training. Further research is needed to evaluate its feasibility in South African rural health systems.
颅外颈动脉动脉瘤和假性动脉瘤较为罕见，占所有外周动脉瘤的比例不到4%。农村初级卫生保健机构由于难以获得正规的影像学检查，常常面临重大挑战。即时超声（PoCUS）有潜力填补这一空白，在偏远地区加快及时诊断和治疗。
一名19岁男性前往南非西开普省的一家农村初级卫生保健诊所就诊，有左侧颈部肿胀3周及近期吞咽痛的病史。体格检查发现一个质地坚硬、有搏动的肿块，可闻及血管杂音。
几个月内无法进行正规的影像学检查，延迟了手术建议。然而，该诊所新购置的移动超声可进行即时超声检查，发现了一个与颈动脉假性动脉瘤相符的搏动性血管病变。计算机断层血管造影证实了诊断，患者被转诊至三级医疗机构进行病变修复。他的组织学检查显示有血管炎，并有结缔组织病的不确定特征，但未找到明确病因。尽管多次尝试，仍无法与他取得联系进行随访。
本病例突出了即时超声在资源有限环境中如何加速确定性治疗。贡献：即时超声在农村医疗环境中可能是一种有效且具有成本效益的诊断工具，但需要在设备和培训方面进行大量投资。需要进一步研究以评估其在南非农村卫生系统中的可行性。
