title: Endovascular treatment of an infected pseudoaneurysm secondary to retropharyngeal abscess in a child.
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.
authors.affiliation: Department of Radiology, Mayo Clinic, USA Brinjikji.waleed@mayo.edu.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Department of Radiology, Mayo Clinic, USA.
authors.forename: Felix E
authors.initials: FE
authors.lastname: Diehn
authors.affiliation: Department of Radiology, Mayo Clinic Health System, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Lindsay
authors.affiliation: Department of Radiology, Mayo Clinic, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Morris
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D020212:Carotid Artery Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D010612:Pharyngitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology; D017703:Retropharyngeal Abscess / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology; D015607:Stents; D013290:Streptococcal Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Endovascular; carotid blowout; coiling; stenting