Article ID: 11282
A 41-year-old woman with a history of heavy-ion therapy 19 years prior for paranasal sinus osteosarcoma was admitted to our hospital due to persistent rhinorrhagia. On Day 3 of hospitalization, the patient developed rebleeding. The bleeding likely originated from the sphenopalatine artery territory, and embolization of the distal right maxillary artery was performed on the same day. On Day 4, a massive rhinorrhagia caused sudden cardiac arrest; however, the patient was successfully resuscitated. On Day 5, the patient underwent right external carotid artery ligation for effective hemostasis. Despite this, active rebleeding occurred on Day 8. On Day 10, she was referred to our department with a strong clinical suspicion of hemorrhage in the right internal carotid artery (ICA). Emergency digital subtraction angiography revealed a pseudoaneurysm involving the C3 segment of the right ICA, with adequate collateral circulation. We performed a parent artery occlusion of the right ICA, including the aneurysm. The patient recovered well postoperatively, without recurrent rhinorrhagia or neurological deficits. Rhinorrhagia caused by a pseudoaneurysm of the ICA can be fatal shortly after its onset. In patients with a history of radiation therapy, a pseudoaneurysm of the ICA should be considered a possible contributing factor. Careful investigation to identify the bleeding source and prompt medical treatment are important.
