Traumatic Pseudoaneurysm in Maxillary Sinus Presenting Intractable Epistaxis: A Case Report of Transarterial Embolization

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Objective: Craniofacial injury with fracture may lead to pseudoaneurysm formation in the external carotid artery system, causing massive epistaxis. In this study, we report a patient with intermittent epistaxis related to a traumatic aneurysm following right blow-out fracture, and review the literature with respect to the pathogenesis and treatment of traumatic aneurysms.

Case Presentation: The patient is a 91-year-old male. He had undergone conservative treatment for right blow-out fracture because he fell down while walking. Subsequently, he had received medication with an iron preparation to control intermittent massive epistaxis. Six months after the head injury, he consulted the Department of Otorhinolaryngology with persistent epistaxis. In the right nasal cavity, a pulsatile mass was detected, suggesting a vascular lesion. He was referred to our department. Neurologically, there were no abnormalities, but marked anemia was noted, and blood transfusion was performed. Head CT revealed a mass occupying the right maxillary sinus. The mass was partially enhanced on contrast-enhanced CT. Angiography showed a pseudoaneurysm, measuring 8 × 10 × 15 mm, originating from a branch of the right internal maxillary artery. Subsequently, transarterial embolization was performed. A microcatheter was inserted to reach the aneurysm, and it was embolized using a liquid embolic material. After surgery, there was no epistaxis, and an improvement of anemia was achieved.

Conclusion: In epistaxis patients with a history of craniofacial injury, it is necessary to differentiate traumatic aneurysms. Endovascular treatment is effective for traumatic aneurysms, and should be selected as a first-choice treatment.