title: Successful endovascular treatment of intractable epistaxis due to ruptured internal carotid artery pseudoaneurysm secondary to invasive fungal sinusitis.
abstract: 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.
authors: Department of Diagnostic Radiology, Chang Gung Memorial Hospital, College of Medicine and School of Medical Technology, Chang Gung University, Chiayi, Taiwan.
authors: Shaner-Yeun
authors: SY
authors: Jao
authors: Hsu-Huei
authors: HH
authors: Weng
authors: Ho-Fai
authors: HF
authors: Wong
authors: Wen-Hung
authors: WH
authors: Wang
authors: Yuan-Hsiung
authors: YH
authors: Tsai
mesh_terms: 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