The Train-Line Pattern on Duplex Ultrasound Helps Differentiate Intramural Thrombus from Atheromatous Plaque in Common Carotid Artery Dissection
<b>Background/Objectives:</b> Common carotid artery dissection (CCAD) can result in severe neurological sequelae; however, its diagnosis may be challenging due to consciousness disturbance and aphasia. The objective of this article is to propose a new imaging feature to assist in the ide...
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2025-05-01
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| author | Ming-Hsing Chang Yen-Yu Huang Fang-I Hsieh Kuan-Yu Lin Hsu-Ling Yeh Kai-Jing Yeh Li-Ming Lien |
| author_facet | Ming-Hsing Chang Yen-Yu Huang Fang-I Hsieh Kuan-Yu Lin Hsu-Ling Yeh Kai-Jing Yeh Li-Ming Lien |
| author_sort | Ming-Hsing Chang |
| collection | DOAJ |
| description | <b>Background/Objectives:</b> Common carotid artery dissection (CCAD) can result in severe neurological sequelae; however, its diagnosis may be challenging due to consciousness disturbance and aphasia. The objective of this article is to propose a new imaging feature to assist in the identification of CCAD. <b>Methods</b>: This retrospective case series enrolled 139 patients with discharge diagnoses of aortic dissection who underwent carotid ultrasound during admission over a period of three years. <b>Results</b>: Among these patients, 23 had type A aortic dissection, and 113 had type B aortic dissection or related conditions. Notably, among the 23 patients with type A aortic dissection, eight had associated common carotid artery dissection (CCAD), and a total of nine CCAD events were identified. Meanwhile, a B-mode ultrasound revealed six double lumens with intimal flaps and three intramural thrombi. The ‘train-line’ pattern in ultrasonography was discerned by detecting a hypoechoic thickened wall, which was characterized by a margin formed by two parallel linear reflections in close proximity. This distinctive “train-line” pattern was identified in three intimal flaps and two intramural thrombi. <b>Conclusions</b>: While double lumens and intramural thrombus are prevalent findings, the latter may be misinterpreted as atherosclerotic plaque. The “train-line” pattern may aid in distinguishing intramural thrombus from atheromatous plaque, offering an additional diagnostic tool alongside the identification of double lumens with intimal flaps. |
| format | Article |
| id | doaj-art-16b7b21faedf4b9aad801e0bf623b7cf |
| institution | OA Journals |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
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| series | Diagnostics |
| spelling | doaj-art-16b7b21faedf4b9aad801e0bf623b7cf2025-08-20T02:33:59ZengMDPI AGDiagnostics2075-44182025-05-011510129710.3390/diagnostics15101297The Train-Line Pattern on Duplex Ultrasound Helps Differentiate Intramural Thrombus from Atheromatous Plaque in Common Carotid Artery DissectionMing-Hsing Chang0Yen-Yu Huang1Fang-I Hsieh2Kuan-Yu Lin3Hsu-Ling Yeh4Kai-Jing Yeh5Li-Ming Lien6Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111045, TaiwanChen Sen-Feng United Clinic, Taipei 114002, TaiwanSchool of Public Health, College of Public Health, Taipei Medical University, Taipei 110301, TaiwanDepartment of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111045, TaiwanDepartment of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111045, TaiwanDepartment of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111045, TaiwanDepartment of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111045, Taiwan<b>Background/Objectives:</b> Common carotid artery dissection (CCAD) can result in severe neurological sequelae; however, its diagnosis may be challenging due to consciousness disturbance and aphasia. The objective of this article is to propose a new imaging feature to assist in the identification of CCAD. <b>Methods</b>: This retrospective case series enrolled 139 patients with discharge diagnoses of aortic dissection who underwent carotid ultrasound during admission over a period of three years. <b>Results</b>: Among these patients, 23 had type A aortic dissection, and 113 had type B aortic dissection or related conditions. Notably, among the 23 patients with type A aortic dissection, eight had associated common carotid artery dissection (CCAD), and a total of nine CCAD events were identified. Meanwhile, a B-mode ultrasound revealed six double lumens with intimal flaps and three intramural thrombi. The ‘train-line’ pattern in ultrasonography was discerned by detecting a hypoechoic thickened wall, which was characterized by a margin formed by two parallel linear reflections in close proximity. This distinctive “train-line” pattern was identified in three intimal flaps and two intramural thrombi. <b>Conclusions</b>: While double lumens and intramural thrombus are prevalent findings, the latter may be misinterpreted as atherosclerotic plaque. The “train-line” pattern may aid in distinguishing intramural thrombus from atheromatous plaque, offering an additional diagnostic tool alongside the identification of double lumens with intimal flaps.https://www.mdpi.com/2075-4418/15/10/1297train-line patterncommon carotid artery dissectioncarotid duplex sonographyaortic dissectionstroke diagnosisneuroimaging |
| spellingShingle | Ming-Hsing Chang Yen-Yu Huang Fang-I Hsieh Kuan-Yu Lin Hsu-Ling Yeh Kai-Jing Yeh Li-Ming Lien The Train-Line Pattern on Duplex Ultrasound Helps Differentiate Intramural Thrombus from Atheromatous Plaque in Common Carotid Artery Dissection Diagnostics train-line pattern common carotid artery dissection carotid duplex sonography aortic dissection stroke diagnosis neuroimaging |
| title | The Train-Line Pattern on Duplex Ultrasound Helps Differentiate Intramural Thrombus from Atheromatous Plaque in Common Carotid Artery Dissection |
| title_full | The Train-Line Pattern on Duplex Ultrasound Helps Differentiate Intramural Thrombus from Atheromatous Plaque in Common Carotid Artery Dissection |
| title_fullStr | The Train-Line Pattern on Duplex Ultrasound Helps Differentiate Intramural Thrombus from Atheromatous Plaque in Common Carotid Artery Dissection |
| title_full_unstemmed | The Train-Line Pattern on Duplex Ultrasound Helps Differentiate Intramural Thrombus from Atheromatous Plaque in Common Carotid Artery Dissection |
| title_short | The Train-Line Pattern on Duplex Ultrasound Helps Differentiate Intramural Thrombus from Atheromatous Plaque in Common Carotid Artery Dissection |
| title_sort | train line pattern on duplex ultrasound helps differentiate intramural thrombus from atheromatous plaque in common carotid artery dissection |
| topic | train-line pattern common carotid artery dissection carotid duplex sonography aortic dissection stroke diagnosis neuroimaging |
| url | https://www.mdpi.com/2075-4418/15/10/1297 |
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