Successful endovascular treatment of intractable epistaxis due to ruptured internal carotid artery pseudoaneurysm secondary to invasive fungal sinusitis.
BACKGROUND
Mycotic pseudoaneurysm from the cavernous segment of the internal carotid artery (ICA) secondary to an invasive aspergillus sinusitis is rare. Surgical intervention with ICA ligation is generally accepted for most mycotic aneurysms or pseudoaneurysms. When presented with massive epistaxis due to a fungal aspergillus ICA invasion, mortality rates are high.


METHODS
We present the case of a 76-year-old man who developed intractable epistaxis due to a mycotic pseudoaneurysm arising from the cavernous segment of the right ICA.


RESULTS
The patient was successfully treated by endovascular embolization at the orifice of the pseudoaneurysm followed by the total ICA trapping technique using electrolytically Guglielmi detachable coils (GDCs) and injection of N-butyl-2-cyanoacrylate (n-BCA). The patient survived for 7 months but eventually died of urosepsis and cardiorespiratory failure.


CONCLUSIONS
Endovascular embolization is a feasible and life-saving approach for emergent management of massive intractable epistaxis secondary to a complicated invasive fungal sinusitis.
Jao
Shaner-Yeun
SY
Department of Diagnostic Radiology, Chang Gung Memorial Hospital, College of Medicine and School of Medical Technology, Chang Gung University, Chiayi, Taiwan.
Weng
Hsu-Huei
HH
Wong
Ho-Fai
HF
Wang
Wen-Hung
WH
Tsai
Yuan-Hsiung
YH
D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D017130:Angioplasty / Q000379:methods; D000800:Angioplasty, Balloon / Q000379:methods*; D001228:Aspergillosis / Q000150:complications* / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal; D004844:Epistaxis / Q000209:etiology / Q000628:therapy; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D011859:Radiography; D018570:Risk Assessment; D012720:Severity of Illness Index; D012852:Sinusitis / Q000150:complications* / Q000000981:diagnostic imaging; D016896:Treatment Outcome