Imaging and Intervention in Internal Carotid Artery Pseudoaneurysm Secondary to Retropharyngeal Abscess
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CLINICAL REPORT
Imaging and Intervention in Internal Carotid Artery Pseudoaneurysm Secondary to Retropharyngeal Abscess Krishna Ramanathan1 • Aruna R. Patil2 • Sunder Narasimhan3 • Satish Nair1
Received: 15 September 2020 / Accepted: 10 November 2020 Ó Association of Otolaryngologists of India 2020
Abstract Vascular complications secondary to retropharyngeal abscess are rarely encountered in the post antibiotic era and include compression of internal carotid artery (ICA), infective arteritis and pseudoaneurysm formation. Post infectious ICA pseudoaneurysm formation is reported predominantly in the paediatric age group and rare in adults. We report a case of retropharyngeal abscess complicated by ICA pseudoaneurysm in an adult successfully managed by endovascular approach.
retropharyngeal abscess is a rare entity in the post antibiotic era. Major vascular complications are compression of internal carotid artery (ICA), infective arteritis and pseudoaneurysm (mycotic/infective aneurysm) formation [2]. Cases of post infectious ICA pseudoaneurysm are predominantly reported in the pediatric age group, such occurrence due to retropharyngeal abscess is a rarity in adults. This case reports retropharyngeal abscess complicated by ICA pseudoaneurysm in an adult which was successfully managed by endovascular approach.
Keywords Parapharyngeal Retropharyngeal Abscess Computed tomography Endovascular Pseudoaneurysm
Case History Introduction Deep neck space infections are a serious but treatable group of infections affecting the deep cervical spaces and are characterized by their rapid progression and lifethreatening complications. The incidence of parapharyngeal space abscess is about 11% and retropharyngeal space abscess is about 5% and majority are due to dental infections [1]. Due to the proximity of the airway and major vessels, complications due to neck space infections are very common. Vascular complication due to & Aruna R. Patil [email protected] 1
Department of Head and Neck Surgery, Apollo Hospitals, Bangalore, Karnataka 560078, India
2
Department of Radiology, Apollo Hospitals, Bangalore, Karnataka 560078, India
3
Department of Vascular Surgery, Apollo Hospitals, Bangalore, Karnataka 560078, India
48 year female presented to the emergency department with a single episode of sudden onset haemoptysis. Patient was a known type 2 diabetes mellitus on treatment (Glargine 10 units, metformin and glimepiride) and had complaints of right sided neck swelling, voice change and dysphagia ten days prior to the current episode. On physical examination, a 3 9 2 cm tense, tender swelling was noted on the right side of the neck. Rigid Hopkin’s endoscopy revealed blood stains over laryngeal cartilages, bilateral pyriform fossa trickling down the posterior pharynx with bulge over the pharyngeal wall (Fig. 1). The vocal cord mobility was normal. No signs of lower cranial nerve palsy or neurological deficits were noted. In view of the warning bleed, patient was admitted. Clinical diagnosis was deep neck space
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