The merit of rural point-of-care ultrasound: Carotid pseudoaneurysm case report

Abstract

Introduction: 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.

Patient presentation: 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.

Management and outcome: 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.

Conclusion: 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.