Nasal Bleeding from a Ruptured Aneurysm of the Internal Carotid Artery Treated with Endovascular Coil Embolization

Abstract

Nasal bleeding can be generally controlled with only intranasal treatment. However, bleeding from large vessels, such as maxillary and internal carotid arteries, is difficult to control only by intranasal treatment, and endovascular treatment is required. Especially nasal bleeding from a ruptured internal carotid artery aneurysm is extremely rare and requires urgent treatment. The patient visited our hospital for sudden nasal bleeding, but the bleeding spontaneously stopped when the patient was first seen. When the blood clot in the natural ostium of the left sphenoid sinus was inhaled at an outpatient situation, massive pulsatile bleeding occurred and continued. The venous route was secured, extracellular fluid was rapidly administered, and tracheal intubation was performed. With computed tomography and angiography examination, the patient was diagnosed with nasal hemorrhage secondary to a ruptured aneurysm in the left internal carotid artery, and the bleeding was controlled by placing endovascular stents and coil in the left internal carotid artery. From the experience of this case, if nasal bleeding occurs around the sphenoidal sinus ostium, clinicians should consider the possibility of nasal bleeding from a ruptured aneurysm of the internal carotid artery and the appropriate treatment should be managed after detailed examinations.