深頸部膿瘍術後に発症した内頸動脈仮性動脈瘤例

抄録

Deep neck abscess is a severe infection encountered in otolaryngology practice, that can be associated with serious complications, such as descending mediastinitis, internal carotid thrombosis, and necrotizing fasciitis; development of pseudoaneurysms has also been reported as a rare complication. Herein, we report successful treatment of a patient with a pseudoaneurysm of the internal carotid artery that developed from an abscess in the carotid artery space, with a review of the literature.

The patient was an 80-year-old man who presented with the chief complaint of swelling in the lower left ear region and fever. Enhanced CT showed an abscess in the carotid artery space. Emergent incision and drainage of the deep neck abscess was performed under general anesthesia. The patient developed cerebral infarction after the operation, and cervical magnetic resonance angiography (MRA) confirmed the presence of a pseudoaneurysm in the left internal carotid artery. We followed up the patient conservatively with blood pressure control, but the aneurysm ruptured. The bleeding was successfully controlled and the patient’s life saved by successful endovascular coil embolization performed by a neurosurgeon.

Endovascular treatment is considered as one of the treatments for a pseudoaneurysm complicating a deep neck abscess.