I saw a specialist( head and neck surgeon)in my area today, Dr.Stepan who is on the list I believe. ( I live in Chicago). Actually I saw her PA because that is
the protocol. I had to see her to get accessed first. The PA knew about Eagle Syndrome and said Dr. Stepan does surgeries for it. She is recommending a CT of the face with and without contrast. I asked if a CTV would be better for checking for compressions but she said the CT of the face will be able to see the styloid processes and surrounding areas in order to diagnose Eagle syndrome. Just curious if just the CT of the face is enough??
Try to get CT of head and neck with and without contrast. Best to see from the top of the head down to clavicle. A CTA with the venous phase of the head and neck would be best. They probably will not do that. So CT H&N W/WO contrast should capture the venous phase to check for vascular compressions.
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That’s what I’m thinking, but not sure if they will order that. The doctor is saying they can view the styloids and area with just the CT of the face. She said it shows the neck too. I might message her and ask
@Ihurt - A face CT should show the styloids just fine. Because CT scans are done in slices & your styloids, IJVs, carotids & hyoid should all be visible. Doctors usually look at the slices for diagnostic purposes. It may be more difficult to see those via 3D images as the facial bones will need to be “peeled” away to see what’s behind them if you convert your CT to 3D.
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She has her protocol and will probably follow it. It is a start which is great. You may or may not need more imaging. You can maybe look at the order through your online health record if you have one. If it just of the head you can try to ask for both. Some reasons to give her for this is to try and avoid further scans/radiation, making sure the SHL and hyoid bone are visible, and to check for venous compression down to the clavicle (especially since you have vascular eagles as the chief complaint and major symptoms). My hope for you is that it is already ordered for both.
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Thank you Isaiah for the response. So will CT of the face show compression of the IJV and other veins? don’t know why she didn’t think I needed a CTV when that’s supposed to be the gold standard. She seemed very sure that just the CT of the face with and without contrast would be sufficient.
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No the order is for CT of the face with and without contrast. On the order it says to evaluate for Eagle syndrome paying special attention to the styloid. She was confident that it will show the styloids and surrounding areas.
A CT with contrast will show compression of any blood vessels- hopefully it’ll be timed to look at the arteries as the blood flows through them into the brain, and then also capture the venous phase as the contrast flows out again… it’s quite confusing as a CTA can be used to describe a CT showing arteries, but sometimes shows the venous phase as well, a CTV can be used to describe the CT showing venous phase, hopefully your CT with contrast will show both!
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@Ihurt - A CT w/ contrast will show the IJVs & carotids, too, & if you have compression when your head is in the neutral position, it will show up. Occasionally a person will need to have his/her head in the position that makes his/her symptoms worse in order for the compression to be really visible, but for most that have compression, the IJV(s) or ICA(s) are compressed at least somewhat even in a neutral head position.
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