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Roy CF, Saint-Martin C, Mascarella M, Girsowicz E, Daniel SJ, Gurberg J, Duval M, Yeung JC. Ruptured Internal Carotid Artery Mycotic Pseudoaneurysm as Sequela to a Retropharyngeal Abscess in an Immunocompetent Child. EAR, NOSE & THROAT JOURNAL 2023:1455613231198990. [PMID: 37705374 DOI: 10.1177/01455613231198990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Affiliation(s)
- Catherine F Roy
- Department of Pediatric Otolaryngology, Montreal Children's Hospital, Montreal, QC, Canada
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Christine Saint-Martin
- Department of Pediatric Radiology, McGill University Health Centre, Montreal, QC, Canada
| | - Marco Mascarella
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Elie Girsowicz
- Department of Vascular Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Sam J Daniel
- Department of Pediatric Otolaryngology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Joshua Gurberg
- Department of Pediatric Otolaryngology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Melanie Duval
- Department of Pediatric Otolaryngology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Jeffrey C Yeung
- Department of Pediatric Otolaryngology, Montreal Children's Hospital, Montreal, QC, Canada
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2
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Hanger M, Baker DM. Infective Native Extracranial Carotid Artery Aneurysms: A Systematic Review. Ann Vasc Surg 2023; 91:275-286. [PMID: 36549478 DOI: 10.1016/j.avsg.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 11/16/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Infective native extracranial carotid artery aneurysms are rare, and their management is variable due to a lack of evidence assessing outcomes. METHODS We performed a systematic literature review following PRISMA guidelines to identify all reported cases of infective native extracranial carotid artery aneurysms between January 1970 and March 2021. RESULTS This study identified 193 infective native aneurysms of the extracranial carotid artery from 154 sources. Patients were predominantly male (71.4%), and age ranged from 6 months to 89 years old. The most common presenting features were a neck mass and fever, but also included hemorrhage, respiratory distress, and neurological symptoms. Most aneurysms were located in the internal carotid artery (47.4%). Staphylococcus (23.3%) was the most commonly identified causative pathogen, followed by Mycobacterium tuberculosis (20.9%). Most appeared to become infected by direct local spread. Treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41 cases. In 4 cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In 5 cases, there was antibiotic treatment alone. In the open surgery-treated group, the complication rate was 20.8% compared to 13.2% in the endovascular group. Mortality rate was 5.6%. CONCLUSIONS Our review identified 193 cases of infective native extracranial carotid artery aneurysms. Direct local spread of a staphylococcus infection was the commonest cause. Endovascular management was associated with fewer early complications than open surgical management.
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Affiliation(s)
- Melissa Hanger
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Daryll M Baker
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK.
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Davidson C, Holihan C, de Oliveira Sillero R, Lee K, Mitchell RB, Shah G. Infectious Pseudoaneurysm of the Internal Carotid Artery in a Child Secondary to Parapharyngeal Abscess. EAR, NOSE & THROAT JOURNAL 2023; 102:NP31-NP34. [PMID: 33393822 DOI: 10.1177/0145561320984582] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Infectious pseudoaneurysm is a rare condition characterized by arterial wall dilation, usually due to an adjacent infectious focus. We present an 8-year-old male with a 3-day history of progressive, severe headache 2 weeks after treatment for a parapharyngeal abscess. Computed tomography revealed a left internal carotid artery (ICA) pseudoaneurysm inferior to the skull base and a small parapharyngeal abscess inferior to the pseudoaneurysm. The patient was admitted for intravenous antibiotic treatment and underwent transfemoral endovascular coil occlusion of the cervical ICA pseudoaneurysm without complications. We discuss the presentation and management of rare vascular complications of parapharyngeal abscesses involving major arteries of the neck and the role of neurointerventional embolization in these cases.
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Affiliation(s)
| | - Cheryl Holihan
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Kenneth Lee
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ron B Mitchell
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gopi Shah
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Carotid mycotic pseudoaneurysm masquerading as a peritonsillar abscess in a pediatric patient: A case report. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sundarrajan C, Isa SA, Caruso JP, Ban VS, Shah GB, Whittemore BA, Sillero R. Treatment of large infectious extracranial carotid artery pseudoaneurysms in children: a systematic review of the literature. Childs Nerv Syst 2021; 37:1461-1470. [PMID: 33590290 DOI: 10.1007/s00381-021-05084-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Extracranial carotid artery pseudoaneurysm is a rare complication of deep neck space infection, and no evidence-based treatment guidelines are available in the literature. METHOD To clarify the existing experience of the different treatment strategies, the authors performed a systematic literature search using the PubMed, Ovid EMBASE, and Scopus databases in accordance with PRISMA guidelines to review all reported cases of pediatric patients with infectious carotid pseudoaneurysms larger than 1 cm. RESULTS Twenty-six patients with a median age of 4 years (range 6 months-15 years) were identified. Eighteen patients (69.2%) were treated with endovascular methods, 6 patients (23.1%) with surgical methods, 1 patient (3.8%) with a hybrid endovascular/surgical approach, and 1 patient (3.8%) with conservative management. Recurrence of the pseudoaneurysm occurred in 2 cases (7.7%), both of which were successfully retreated. Of the 6 patients (23.1%) who presented with pre-procedure neurologic deficits, 3 patients had complete or near complete resolution of symptoms after intervention and 3 patients had persistent deficits at last follow-up. Four patients (15.4%) experienced new neurologic deficits post-procedure that resolved at last follow-up. CONCLUSION The endovascular treatment tends to be the preferred option to treat a large or giant infectious pseudoaneurysm of the carotid artery in the pediatric patient. However, more evidence is necessary to elucidate comparative safety and efficacy profiles of endovascular and surgical management strategies.
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Affiliation(s)
- Chandrasekhar Sundarrajan
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Samya A Isa
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - James P Caruso
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Vin Shen Ban
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Gopi B Shah
- Division of Pediatric Otolaryngology, Children's Health, Dallas, TX, 75235, USA
| | - Brett A Whittemore
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.,Division of Pediatric Neurosurgery, Children's Health, Dallas, TX, 75235, USA
| | - Rafael Sillero
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA. .,Division of Pediatric Neurosurgery, Children's Health, Dallas, TX, 75235, USA.
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Lu WL, Wang B, Wu F, Wang MY, Pan JX, Xu H. Covered Stent–Assisted Open Surgery in the Treatment of an Extracranial Carotid Artery Pseudoaneurysm. Ann Vasc Surg 2019; 57:238-243. [DOI: 10.1016/j.avsg.2018.08.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/11/2018] [Accepted: 08/08/2018] [Indexed: 12/18/2022]
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Eriksen PRG, Hvilsom GB, Homøe P. Infected "Mycotic" Aneurysm of the Common Carotid Artery-A Differential Diagnosis to Tumor of the Neck. Front Surg 2019; 5:75. [PMID: 30619876 PMCID: PMC6297873 DOI: 10.3389/fsurg.2018.00075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/26/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Infected "mycotic" Aneurysm (IA) of the extracranial carotid artery is a rare condition that can be fatal if mistaken for other pathology. An 83-year-old man presented with a mass on the neck initially suspected malignant. Weeks later it grew rapidly and was found to be an IA, thus requiring acute surgery. Via this case report, we discuss diagnostics and approach when diagnosing masses in relation to vessels of the neck not readily explained. Case Report: After diagnostic imaging and clinical assessment an unknown primary tumor of the neck was suspected. Fine needle aspiration was inconclusive. The patient did not present with any signs of infection or neurological symptoms-only discomfort and pain. Approximately two weeks later, the mass grew and the patient became dysphagic, febrile, and confused. Computed tomography angiography revealed an IA of the right common carotid artery. The patient underwent acute surgery consisting of ligation of the internal and external carotid arteries and resection of the internal jugular vein. The pathogen found was E. coli, supposedly from the bladder after surgical intervention due to polyposis. Conclusion: IA is a very rare entity and can have many etiologies. Since it can be fatal, it is necessary to keep IA in mind when diagnosing masses in relation to vessels of the neck. As shown in this case of a E. coli-induced IA, patients can present with atypical symptoms, on diagnostic imaging it can be mistaken for other pathology, and pathogenesis can be unclear.
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Affiliation(s)
- Patrick R G Eriksen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Gitte B Hvilsom
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
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Pinzón M, Lobelo NO, Rodríguez MC, Villamor P, Otoya AM. Endovascular management of iatrogenic cervical internal carotid artery pseudoaneurysm in a 9-year-old child: Case report and literature review. Int J Pediatr Otorhinolaryngol 2017; 95:29-33. [PMID: 28576528 DOI: 10.1016/j.ijporl.2017.01.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/21/2017] [Accepted: 01/26/2017] [Indexed: 11/29/2022]
Abstract
Extracranial internal carotid artery (ICA) pseudoaneurysms are uncommon in the pediatric population and are usually secondary to direct trauma to the vessel. Treatment options include surgery (ligation), anticoagulation therapy and endovascular treatment. Endovascular covered stents have shown good results in adult populations, resulting in occlusion of the aneurysm and preservation of the artery without significant complications. However, there have been only limited reports in the literature reporting endovascular carotid stent placement in the pediatric population. We report a case of a 9-year-old boy patient, who developed a cervical ICA pseudoaneurysm after a parapharyngeal tumor resection. He was successfully treated by primary endovascular covered stent placement. During a follow-up of 6 months the patient has been asymptomatic, without any adverse event. Additionally, a literature review is done.
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Affiliation(s)
- Martín Pinzón
- Department of Otolaryngology, Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - Nelson Oswaldo Lobelo
- Department of Radiology, Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - María Claudia Rodríguez
- Department of Otolaryngology, Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - Perla Villamor
- Department of Otolaryngology, Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.
| | - Ana María Otoya
- Department of Otolaryngology, Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
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Ruff MW, Nasr DM, Klaas JP, Renaud DL. Internal Carotid Artery Pseudoaneurysm and Ischemic Stroke Secondary to Retropharyngeal and Parapharyngeal Abscess. J Child Neurol 2017; 32:230-236. [PMID: 27888269 DOI: 10.1177/0883073816678556] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Internal carotid artery pseudoaneurysm is an uncommon complication of retropharyngeal and parapharyngeal abscess in children. Treatment of the pseudoaneurysm has evolved in recent years from surgical ligation to endovascular techniques. Neurologic sequelae most commonly consist of Horner's syndrome with cerebral ischemia being uncommon. The clinical course of a 2-year-old boy with retropharyngeal abscess complicated by internal carotid artery pseudoaneurysm, is described and the literature is reviewed. A conventional angiogram confirmed the presence of a large pseudoaneurysm with no anterograde flow distal to the pseudoaneurysm and substantial collateral flow across the circle of Willis, with filling of the left anterior and middle cerebral arteries via the anterior and posterior communicating arteries. Endovascular occlusion resulted in nonfilling of the left internal carotid artery, pseudoaneurysm, and left internal jugular vein at the base of the skull. Following the procedure, the patient developed transient mild right hemiparesis associated with frontal lobe ischemia.
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Affiliation(s)
- Michael W Ruff
- 1 Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Deena M Nasr
- 1 Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - James P Klaas
- 1 Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Deborah L Renaud
- 1 Department of Neurology, Mayo Clinic, Rochester, MN, USA
- 2 Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
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Steinberg J, Cheung V, Goel G, Pannell JS, Nation J, Khalessi A. Vessel-preserving stent-assisted coil embolization of an extracranial internal carotid artery pseudoaneurysm that developed after tonsillectomy in a pediatric patient: initial case report. J Neurosurg Pediatr 2017; 19:8-12. [PMID: 27689245 DOI: 10.3171/2016.7.peds14457] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although there have been reports of carotid artery pseudoaneurysm formation after adenoidectomy and/or tonsillectomy secondary to iatrogenic injury, there are no case reports of successful endovascular reconstruction of the injured artery in the pediatric population. In most pediatric cases, the internal carotid artery (ICA) is sacrificed. The authors report on a 6-year-old girl who presented with odynophagia, left-sided Horner's syndrome, hematemesis, and severe anemia 6 months after a tonsillectomy. On examination she was found to have a pulsatile mass along the left posterior lateral oropharynx, and imaging demonstrated a dissection of the extracranial left ICA and an associated pseudoaneurysm. The lesion was managed endovascularly with stent-assisted coil embolization and ICA reconstruction. The child had a somewhat complicated postoperative course, requiring additional coil embolization for treatment of a minor recurrence of the pseudoaneurysm at 5 months after the initial treatment and then presenting with extrusion of a portion of the coil mass into the oropharyngeal cavity a year later. She underwent surgical removal of the extruded coils and repair of the defect and has since been free of symptoms or signs of recurrence. The authors conclude that this strategy definitively protected the patient against an oral exsanguination or aspiration event secondary to aneurysm rupture and reduced her risk of stroke by preserving vessel patency and caliber. Moreover, they note that covered stent reconstruction surrenders endovascular access and cannot immediately provide these benefits.
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Affiliation(s)
| | | | | | | | - Javan Nation
- Division of Otolaryngology, University of California, San Diego, California
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Katsevman GA, Braca JA, Welch KC, Ashley WW. Delayed Presentation of an Extracranial Internal Carotid Artery Pseudoaneurysm and Massive Epistaxis Secondary to a Nasal Foreign Body: Case Report and Review of the Literature. World Neurosurg 2016; 92:585.e13-585.e19. [DOI: 10.1016/j.wneu.2016.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/08/2016] [Accepted: 05/09/2016] [Indexed: 01/04/2023]
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Extracranial internal carotid artery pseudoaneurysm in a two-year-old child: case report. The Journal of Laryngology & Otology 2016; 130:596-9. [PMID: 27093977 DOI: 10.1017/s0022215116001109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Extracranial internal carotid artery pseudoaneurysm is very rare in children. METHOD This paper discusses the case of a boy, aged two years and six months, who presented with an enlarging neck mass and unilateral bloody otorrhoea. Special investigations revealed an extracranial internal carotid artery pseudoaneurysm. RESULTS The patient made a full recovery after endovascular occlusion of the internal carotid artery and pseudoaneurysm using coils. At six months' follow up, the internal carotid artery and pseudoaneurysm remained excluded from the circulation. The patient did not display any neurological deficits during hospital stay or follow up. CONCLUSION This paper reports on one of the youngest patients documented to date who presented with an internal carotid artery pseudoaneurysm, possibly secondary to ear infection. Although rare, this condition should be excluded in children presenting with a mass of the neck or pharynx because of the dire consequences if left undiagnosed and untreated.
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Requejo F, Lipsich F, Jaimovich R, Zuccaro G. Neurovascular stents in pediatric population. Childs Nerv Syst 2016; 32:505-9. [PMID: 26715300 DOI: 10.1007/s00381-015-2992-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/21/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the study is to analyze the results obtained using stents for the treatment of neurovascular diseases in pediatric patients. METHODS A retrospective study of 6-year period was undertaken evaluating clinical charts and imaging studies of patients treated with stents because of neurovascular diseases. RESULTS Nine patients were managed with 10 stents. Seven children were females. The median age was 11 years. There were four cases of broad neck cerebral aneurysms, a pseudoaneurysm of the cervical internal carotid artery, a vertebro-jugular fistula, two patients with internal carotid artery (ICA) stenosis affecting the cervical and supraclinoid segment, and a vertebral artery dissection. The only complication was a silent posterior communicating artery (PCoA) thrombosis in a PCoA aneurysm treated with two stents. Dual antiplatelet therapy was given after the procedure to avoid in stent thrombosis. CONCLUSION Stents are safe and effective for treatment of neurovascular diseases in children, but studies are needed in order to protocolize the use of antiplatelet drugs in children.
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Affiliation(s)
- Flavio Requejo
- Hospital Nacional de Pediatria JP Garrahan, Buenos Aires, Argentina.
| | - Federico Lipsich
- Hospital Nacional de Pediatria JP Garrahan, Buenos Aires, Argentina
| | | | - Graciela Zuccaro
- Hospital Nacional de Pediatria JP Garrahan, Buenos Aires, Argentina
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Brinjikji W, Diehn FE, Lindsay CW, Morris JM. Endovascular treatment of an infected pseudoaneurysm secondary to retropharyngeal abscess in a child. Interv Neuroradiol 2015; 21:538-42. [PMID: 26060279 DOI: 10.1177/1591019915590073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We describe a rare case of carotid pseudoaneurysm secondary to a retropharyngeal abscess, treated with coil embolization in a 2-year-old boy. The patient presented to an emergency department with symptoms suggesting meningitis but was subsequently diagnosed with streptococcal pharyngitis. He was discharged home on oral antibiotics after a short hospitalization. He returned to the emergency department two weeks later with limited neck motion and pain. Neck CT demonstrated a retropharyngeal abscess with a large left cervical internal carotid artery (ICA) pseudoaneurysm. The petrous ICA distal to the pseudoaneurysm had thrombosed prior to treatment. The ICA proximal to the pseudoaneurysm was sacrificed with coil embolization. Post-treatment imaging demonstrated complete thrombosis of the pseudoaneurysm but also demonstrated acute strokes in the left MCA/ACA watershed distribution. His parents noted that the patient was clumsier and exhibited some mild speech changes and a steppage gait prior to evaluation in the ED; therefore, these were thought to be secondary to emboli from partial thrombosis of the pseudoaneurysm prior to treatment. The patient was discharged home in good condition and his neurological function improved.
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Baker A, Rizk H, Carroll W, Lambert P. Cervical internal carotid Artery pseudoaneurysm complicating malignant otitis externa: First case report. Laryngoscope 2014; 125:733-5. [DOI: 10.1002/lary.24877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/16/2014] [Accepted: 07/21/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Andrew Baker
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Habib Rizk
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - William Carroll
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Paul Lambert
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
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