Unrecognized carotid artery stenosis - Discovered by calcifications on a panoramic radiograph

Background. Approximately 730,000 strokes occur each year in the United Sta tes, costing an estimated $40 billion annually. One-half of all strokes are the result of atherosclerotic plaques found in the carotid artery. Such pl aques frequently are heavily calcified and can be identified on a panoramic radiograph by the incidental finding of calcifications overlying the carot id bifurcation. Case Description. The authors found that a 67-year-old asymptomatic woman h ad calcium deposits overlying both carotid bifurcation regions on a panoram ic radiograph. Subsequent duplex ultrasonic examination indicated bilateral , high-grade carotid arterial stenoses. The patient underwent uneventful bi lateral carotid endarterectomy. Clinical Implications. The patient had critical carotid arterial stenoses a ssociated with significant risk of stroke that had not been identified othe rwise. The findings on the panoramic radiograph led to appropriate and pote ntially life-saving treatment. While the positive predictive value of this finding has yet to be defined, the authors believe that calcifications over lying the carotid system region seen on panoramic radiography in an asympto matic patient should be followed by formal evaluation of the carotid bifurc ation.