Ruptured internal carotid artery aneurysm following surgery for chronic sinusitis: delayed presentation: a case report

Rupture of internal carotid artery aneurysm has high mortality rate and needs high index of suspicion for immediate management. Massive epistaxis after rupture of aneurysms in the petrous part of internal carotid artery is extremely rare. In this paper, we report the first case of delayed rupture of a petrous carotid aneurysm which developed because of chronic allergic sinusitis.

Petrous internal carotid artery aneurysm rupture induced by Eustachian tube catheterisation: case report

BACKGROUND

Petrous internal carotid artery aneurysms are very rare vascular lesions, which may present with otalgia and life-threatening massive otorrhoea.

CASE REPORT

An 84-year-old woman presented at a local otolaryngology clinic with progressive otalgia due to an acute exacerbation of chronic otitis media. She was referred with left-sided massive otorrhoea following Eustachian tube catheterisation. She suffered another massive otorrhoea with epistaxis during left-sided ear cleaning at a clinic visit. Contrast-enhanced computed tomography and computed tomography angiography revealed a left-sided aneurysm and adjacent stenosis at the left internal carotid artery. Coil embolisation of the petrous internal carotid artery aneurysm was performed with percutaneous transluminal angioplasty followed by dilatation of the stenosis.

CONCLUSION

Computed tomography angiography should be performed immediately when a patient reports massive otorrhoea. Endovascular occlusion is a treatment option as it avoids complications of open surgical ligation procedures.

Endovascular management of a giant petrous internal carotid artery aneurysm in a child. Case report and literature review

BACKGROUND

Aneurysms of the petrosal segment of the internal carotid artery are rare in children and are usually found secondary to trauma and infection or can have a congenital origin. Management includes endovascular therapy, surgery, and in rare cases observation.

DISCUSSION

Here, we report our experience with a giant petrous internal carotid artery aneurysm in a 16-year-old boy successfully managed endovascularly by parent artery occlusion.

The treatment of pseudoaneurysms with flow diverters after malignant otitis externa

Background We report a case of bilateral malignant otitis externa complicated with bilateral petrous internal carotid artery pseudoaneurysms and their successful treatment with a flow diverter. Case report A 68-year-old woman with serious complications of type II diabetes mellitus had malignant otitis externa on the right side. She was treated with combined antibiotic therapy and underwent mastoidectomy for mastoiditis. She presented at our hospital with acute hemorrhage from the right external auditory canal. The emergency computed tomography (CT) angiography revealed a multiobulated pseudoaneurysm at the petrous segment of the right internal carotid artery. The pseudoaneurysm was treated with a 5 × 40-mm Surpass flow diverter. Three months later, she developed a malignant external otitis on the left side. As the infection progressed, a left-sided mastoiditis, a brain abscess, and a pseudoaneurysm at the petrous segment of the left internal carotid artery developed. The pseudoaneurysm caused bleeding from the left ear, and was treated with a 5 × 50-mm Surpass flow diverter. No recurrent bleeding was observed. Four months later, a follow-up angiography showed complete occlusion of the pseudoaneurysm on the left side, but a residual aneurysm could be detected on the right side. One year after the first intervention, the follow-up CT and magnetic resonance angiography revealed the complete occlusion of the aneurysms bilaterally. Conclusion The use of a flow diverter appears to be an efficient and safe method to occlude carotid pseudoaneurysms even in an inflammatory milieu.

Stent-assisted Coil Embolization of Petrous ICA in a Teenager with Neurofibromatosis

We herein report on a patient with a cerebral aneurysm located at the petrous portion of the internal carotid artery (ICA). An 18-year-old male, previously diagnosed with neurofibromatosis, was referred to our emergency service complaining of severe headache, pulsatile tinnitus, nausea, and vomiting which occurred suddenly. Neuro-radiological studies including computed tomography and magnetic resonance imaging of the cerebral artery showed a large aneurysm arising from the petrous segment of the left ICA. He was treated with a neuro-interventional technique such as intra-arterial stenting and coil embolization for the aneurysm. Several days after the interventional treatment, his symptoms were resolved gradually except for a mild headache. Symptomatic unruptured aneurysm at the petrous portion of the ICA is rare, and our patient was treated successfully using a neuro-intervention technique. Therefore, we describe a case of a petrous aneurysm treated with endovascular coils without compromising the ICA flow, and review the literature.

Pseudoaneurysm of the Petrosal Internal Carotid Artery in the Middle Ear as a Complication of Middle Ear Cholesteatoma

We report the case of a 66-year-old man who had significant otorrhagia caused by a ruptured pseudoaneurysm in the petrous internal carotid artery (ICA). The patient had middle ear cholesteatoma, and computed tomography (CT) showed bony erosion and exposure of the ICA into the middle ear cavity. Further angiography of the right carotid artery revealed a pseudoaneurysm protruding from the petrosal ICA into the middle ear cavity. The pseudoaneurysm was promptly treated with coil embolization and stenting. The patient continues to be monitored regularly with clinical follow-up, and carotid angiography and temporal bone CT revealed no interval changes at the embolized site 3 years after the procedure.

Cervical-petrous internal carotid artery pseudoaneurysm presenting with otorrhagia treated with endovascular techniques

Cervical-petrous internal carotid artery (CP-ICA) pseudoaneurysms are rare and have different etiologies, presentations, and treatment options. A middle-aged patient with a history of chronic otitis media presented with acute otorrhagia and was found to have a left-sided CP-ICA pseudoaneurysm. The patient was a poor surgical candidate with difficult arterial access. The pseudoaneurysm was treated with stand-alone coiling via a left brachial approach with persistent contrast filling seen only in the aneurysm neck at the end of the procedure. The patient re-presented 12 days later with repeat hemorrhage and rapid enlargement of the neck remnant, and was treated with a covered stent via a transcervical common carotid artery cut-down. A covered stent may provide a more definitive treatment for CP-ICA pseudoaneurysms compared with standalone coiling.

Cervical-petrous internal carotid artery pseudoaneurysm presenting with otorrhagia treated with endovascular techniques

Cervical-petrous internal carotid artery (CP-ICA) pseudoaneurysms are rare and have different etiologies, presentations, and treatment options. A middle-aged patient with a history of chronic otitis media presented with acute otorrhagia and was found to have a left-sided CP-ICA pseudoaneurysm. The patient was a poor surgical candidate with difficult arterial access. The pseudoaneurysm was treated with stand-alone coiling via a left brachial approach with persistent contrast filling seen only in the aneurysm neck at the end of the procedure. The patient re-presented 12 days later with repeat hemorrhage and rapid enlargement of the neck remnant, and was treated with a covered stent via a transcervical common carotid artery cut-down. A covered stent may provide a more definitive treatment for CP-ICA pseudoaneurysms compared with standalone coiling.

Pseudomonas aeruginosa intrapetrous internal carotid artery mycotic aneurysm--a complication of mastoiditis: first reported case

Mycotic aneurysms of the intrapetrous carotid artery are a rare complication of adjacent middle ear infections that occur by direct invasion of arterial adventitia. We report the first case of a Pseudomonas aeruginosa mycotic intrapetrous carotid aneurysm arising from mastoiditis, confirmed with middle ear cultures, presenting with high-grade bacteraemia and otorrhagia in a diabetic man. Infection was related to elective myringotomy tube placement and was initially treated with empiric antibiotics. Diagnosis required careful evaluation of imaging studies, particularly MR angiography. Resolution required aggressive debridement and carefully selected long-term intravenous antibiotics, appropriate for carefully determined antibiotic sensitivity of his pathogen, but no neurosurgical intervention. He has had no evidence of recurrence over the subsequent year. We offer our experience to highlight the dangers of invasive P aeruginosa middle ear infections in patients with diabetes to other practitioners and to encourage earlier, more aggressive intervention.