Endovascular occlusion of a carotid pseudoaneurysm complicating deep neck space infection in a child. Case report.
Pseudoaneurysm formation of the cervical internal carotid artery (ICA) is a rare, potentially lethal complication of deep neck space infection. This entity typically occurs following otolaryngological or upper respiratory tract infection. The pseudoaneurysm is heralded by a pulsatile neck mass, Homer's syndrome, lower cranial neuropathies, and/or hemorrhage that may be massive. The recommended treatment includes prompt arterial ligation. The authors present a case of pseudoaneurysm of the cervical ICA complicating a deep neck space infection. A parapharyngeal Staphylococcus aureus abscess developed in a previously healthy 6-year-old girl after she experienced pharyngitis. The abscess was drained via an intraoral approach. On postoperative Day 3, the patient developed a pulsatile neck mass, lethargy, ipsilateral Horner's syndrome, and hemoptysis, which resulted in hemorrhagic shock. Treatment included emergency endovascular occlusion of the cervical ICA and postembolization antibiotic treatment for 6 weeks. The patient has made an uneventful recovery as of her 18-month follow-up evaluation. Conclusions drawn.from this experience and a review of the literature include the following: 1) mycotic pseudoaneurysms of the carotid arteries have a typical clinical presentation that should enable timely recognition; 2) these lesions occur more commonly in children than in adults; 3) angiography with a view to performing endovascular occlusion should be undertaken promptly; and 4) endovascular occlusion of the pseudoaneurysm is a viable treatment option.
Reisner
A
A
Department of Neurosurgery, University of Louisville School of Medicine, Kentucky, USA.
Marshall
G S
GS
Bryant
K
K
Postel
G C
GC
Eberly
S M
SM
D000038:Abscess / Q000382:microbiology*; D000328:Adult; D017541:Aneurysm, False / Q000382:microbiology / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000382:microbiology / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000382:microbiology; D002648:Child; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006469:Hemoptysis / Q000175:diagnosis; D006732:Horner Syndrome / Q000175:diagnosis; D006801:Humans; D009333:Neck / Q000382:microbiology*; D010608:Pharyngeal Diseases / Q000382:microbiology*; D010612:Pharyngitis / Q000382:microbiology; D012771:Shock, Hemorrhagic / Q000175:diagnosis; D012894:Sleep Stages; D013203:Staphylococcal Infections / Q000150:complications*