Abstract
A 60-year-old woman, a housebound patient for COVID-19, visited her previous doctor because of a worsening sore throat. A simple CT showed swelling around the left tonsil with gas shadows, and so she was transferred to our hospital during the night for a close examination and treatment for a suspected left peritonsillar abscess. At admission, a video endoscopy of the larynx showed blood accumulation in the hypopharynx and swelling from the left tonsil to the lateral pharynx. Antibiotic therapy was started, but active bleeding was observed in the oral cavity the next day. Contrast-enhanced CT showed a pseudoaneurysm at a branch of the external carotid artery running into the abscess cavity, which was thought to be involved in the bleeding. We planned to perform an emergency tracheostomy and interventional radiology. However, airway obstruction occurred prior to surgery, and patient was secured through an immediate cricothyrotomy. After that, emergency IVR was performed, and bleeding from a pseudoaneurysm of the tonsillar branch of the left facial artery was suspected. Embolization was performed and the bleeding was controlled and recovered. In cases of active bleeding from the pharynx, we should suspect the presence of a pseudoaneurysm and immediately secure the airway.
