Carotid Blowout Syndrome in the Emergency Department: A Case Report and Review of the Literature

CTA and DSA findings in carotid blowout syndrome: An overview and approach to imaging diagnosis

Carotid blowout syndrome (CBS) is a potentially life-threatening complication in patients suffering head and neck cancer, in which rupture of the carotid artery and/or its branches can rapidly lead to life-threatening hemorrhage, shock, and death. CBS is categorized into three subtypes, which are characterized by extent of disease as evidenced by clinical presentation, physical exam findings, and imaging characteristics. Given the high morbidity and mortality associated with CBS, prompt recognition and treatment remains pivotal, as early intervention is associated with longer survival and lower complication rates. In turn, we present an overview of the hallmark imaging findings of CBS through a retrospective review of our institution's findings of these characteristic imaging findings in all patients who underwent evaluation and management of CBS at our facility across a 10-year period.

Emergency Management and Nursing Considerations of Carotid Blowout Syndrome

INTRODUCTION

Carotid blowout syndrome is a rare but fatal complication often witnessed secondary to treating patients with head and neck cancer. It occurs when damage and necrosis lead to the carotid artery wall rupture. The symptoms encountered in these patients range from asymptomatic to cardiac arrest. Here, we present 5 cases of carotid blowout syndrome in the emergency department.

CASE PRESENTATIONS

Patients demonstrated symptoms ranging from subtle bleeding to hemodynamic instability, highlighting the diverse nature of carotid blowout syndrome in this population. Notably, while all patients had a history of radiotherapy, some had additional risk factors for carotid blowout syndrome, including prior surgery (n = 2), malnutrition (n = 3), and tracheostomies (n = 2). Definitive diagnoses were established through clinical evaluation and computed tomography angiography. Immediate interventions included bleeding control, resuscitation, and consultations with relevant specialties. Four patients underwent interventional radiology procedures, and 1 patient received otolaryngology care. While 2 patients recovered completely, 1 died in the emergency department, and 1 in the intensive care unit. One patient's clinical course was complicated by a stroke.

CONCLUSION

The approach to the carotid blowout syndrome patient includes complex steps that proceed in a multidisciplinary manner, starting from triage until discharge. Emergency nurses play crucial roles at every stage. They should be aware of carotid blowout syndrome when evaluating patients with head and neck cancer presenting with bleeding. When treating these patients, emergency nurses should be ready for airway interventions, bleeding control, and massive transfusion protocol. In this context, the multifaceted approaches made by nurses contribute significantly to carotid blowout syndrome management in the emergency department.

Brain abscesses following carotid blowout syndrome: a case report

We report a case of intracranial abscesses development in a patient with head and neck cancer after emergent treatment of carotid blowout syndrome with coil embolization. Our patient is a 60-year-old male who presented with hemoptysis and hematemesis, which raised concerns for impending carotid blowout syndrome. Endovascular occlusion was successfully achieved, and the patient was discharged in stable condition. Ten days later, the patient reported headaches and right facial pain, and magnetic resonance imaging revealed multiple intracranial abscesses. Broad-spectrum intravenous antibiotics were administered, leading to a variable response with some abscesses decreasing in size and others increasing. Seven weeks from discharge, the patient had no neurological deficits, and all abscesses had decreased in size.