CASE REPORTS
A Rare Cause of Recurrent Massive Epistaxis: Post-traumatic Cavernous Carotid Artery Pseudoaneurysm
Rekürren Massif Burun Kanamasının Nadir Bir Nedeni: Travma İlişkili Kavernöz Karotis Psödoanevrizması
Received Date : 04 Jul 2020
Accepted Date : 07 Oct 2020
Available Online : 11 Feb 2020
Erdoğan ÖZGÜRa, Coşkun ATAYa, İbrahim Önder YENİÇERİb, Mehmet Serkan GÜRc
aDepartment of Otorhinolaryngology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, TURKEY
bDepartment of Radiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, TURKEY
cDepartment of Radiology, İzmir Katip Çelebi University Faculty of Medicine, İzmir, TURKEY
Doi: 10.24179/kbbbbc.2020-77880 - Makale Dili: EN
KBB ve BBC Dergisi. 2021;29(1):69-73
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Internal carotid artery pseudoaneurysm due to head
trauma is an extremely rare but life-threatening condition. A pseudoaneurysm
in the cavernous segment of the internal carotid artery should
be considered in patients with ocular region injury, unilateral vision
loss and delayed epistaxis. In cases of cavernous carotid pseudoaneurysm,
a period between trauma and the first episode of epistaxis is
usually observed. In this paper, a 36-year-old patient with cavernous
carotid pseudoaneurysm related to head trauma is presented. The patient's
epistaxis started approximately 5 months after the trauma. On his
examination, a pulsatile mass in the left nasal cavity was detected, and
a diagnosis of giant cavernous carotid pseudoaneurysm was made with
computed tomography-angiography imaging. Then, he was successfully
treated with coil embolization in the interventional radiology unit.
Keywords: Epistaxis; aneurysm, false; carotid artery, internal; carotid artery injuries; cavernous sinus
ÖZET
Kafa travmasına bağlı internal karotid arter psödoanevrizması,
oldukça nadir görülen ve yaşamı tehdit eden bir durumdur. Özellikle
oküler bölgede kemik kırığı, tek taraflı görme kaybı, gecikmiş burun
kanaması bulguları saptanan bir hastada, internal karotid arterin kavernöz
segmentinde psödoanevrizma olabileceği akla gelmelidir. Kavernöz
karotis psödoanevrizması olgularında, genellikle travma ile ilk
burun kanaması atağı arasında bir periyot gözlenir. Bu çalışmada, 36
yaşında kafa travması ile ilişkili kavernöz karotis psödoanevrizması
olan bir olgu sunulmuştur. Olgunun, travmadan yaklaşık 5 ay sonra
masif ve tekrarlayıcı karakterde burun kanaması başlamıştı. Muayenesinde
sol nazal kavitede pulsatil kitle saptanan hastaya uygulanan bilgisayarlı
tomografi-anjiyografi görüntüleri ile dev kavernöz karotis
psödoanevrizması tanısı kondu. Ardından girişimsel radyoloji ünitesinde
koil embolizasyon ile başarılı bir şekilde tedavi edildi.
Anahtar Kelimeler: Epistaksis; anevrizma, yalancı; karotis arter, internal; karotis arter yaralanmaları; kavernöz sinüs
KAYNAKLAR
- Chen G, Li J, Xu G, Qin S, Gong J, Yang M, et al. Diagnosis and treatment of traumatic internal carotid artery pseudoaneurysm primarily manifested by repeated epistaxis. Turk Neurosurg. 2013;23(6):716-20.[Crossref] [PubMed]
- Sridharan R, Low SF, Mohd MR, Kew TY. Intracavernous internal carotid artery pseudoaneurysm. Singapore Med J. 2014;55(10):e165-8.[Crossref] [PubMed] [PMC]
- Bhatoe HS, Suryanarayana KV, Gill HS. Recurrent massive epistaxis due to traumatic intracavernous internal carotid artery aneurysm. J Laryngol Otol. 1995 Jul;109(7):650-2.[Crossref] [PubMed]
- Asma A, Putra SH, Saim L. Massive epistaxis secondary to pseudoaneurysm of internal carotid artery. Med J Malaysia. 2006;61(1):84-7.[PubMed]
- Chen D, Concus AP, Halbach VV, Cheung SW. Epistaxis originating from traumatic pseudoaneurysm of the internal carotid artery: diagnosis and endovascular therapy. Laryngoscope. 1998;108(3):326-31.[Crossref] [PubMed]
- Stiebel-Kalish H, Kalish Y, Bar-On RH, Setton A, Niimi Y, Berenstein A, et al. Presentation, natural history, and management of carotid cavernous aneurysms. Neurosurgery. 2005;57(5):850-7.[Crossref] [PubMed]
- Zipfel GJ, Dacey RG. Update on the management of unruptured intracranial aneurysms. Neurosurg Focus. 2004;17(5):E2.[Crossref] [PubMed]
- Ruiz-Juretschke F, Castro E, Mateo Sierra O, Iza B, Manuel Garbizu J, Fortea F, et al. Massive epistaxis resulting from an intracavernous internal carotid artery traumatic pseudoaneurysm: complete resolution with overlapping uncovered stents. Acta Neurochir (Wien). 2009;151(12):1681-4.[Crossref] [PubMed]
- Han MH, Sung MW, Chang KH, Min YG, Han DH, Han MC. Traumatic pseudoaneurysm of the intracavernous ICA presenting with massive epistaxis: imaging diagnosis and endovascular treatment. Laryngoscope. 1994;104(3 Pt 1):370-7.[Crossref] [PubMed]
- Chambers EF, Rosenbaum AE, Norman D, Newton TH. Traumatic aneurysms of cavernous internal carotid artery with secondary epistaxis. AJNR Am J Neuroradiol. 1981;2(5):405-9.[PubMed]
- Higashida RT, Halbach VV, Dowd C, Barnwell SL, Dormandy B, Bell J, et al. Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms: results in 87 cases. J Neurosurg. 1990;72(6):857-63.[Crossref] [PubMed]
- Choulakian A, Drazin D, Alexander MJ. Endosaccular treatment of 113 cavernous carotid artery aneurysms. J Neurointerv Surg. 2010;2(4):359-62.[Crossref] [PubMed]
- Lempert TE, Halbach VV, Higashida RT, Dowd CF, Urwin RW, Balousek PA, et al. Endovascular treatment of pseudoaneurysms with electrolytically detachable coils. AJNR Am J Neuroradiol. 1998;19(5):907-11.[PubMed]
