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[Infectious aneurysms of the cavernous carotid artery]
K Marsot-Dupuch1, S Riachi, K Berthet
1Service de Radiologie, Hôpital Saint-Antoine, 184, rue du Faubourg St-Antoine, 75012 Paris. kathlyn.marsot-dupuch@sat.ap-hop-paris.fr
Insights
Infectious aneurysms of the cavernous carotid artery, often caused by sinusitis or endocarditis, require prompt diagnosis and management. Early detection via advanced imaging and potential carotid artery occlusion are crucial for patient outcomes.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Neurology
Background:
- Infectious aneurysms of the cavernous carotid artery are rare but serious vascular complications.
- Common causes include sphenoidal sinusitis and endocarditis, leading to septic emboli or contiguous spread.
Observation:
- Three patients presented with acute cavernous sinus syndrome, initially suspected as thrombophlebitis.
- Diagnosis was confirmed using magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA).
Findings:
- Aneurysmal fissuration, indicated by epistaxis or blood in the sphenoid sinus, necessitated therapeutic internal carotid artery occlusion in all three patients.
- Management involved antibiotherapy and close clinical and imaging follow-up.
Implications:
- This case series highlights the importance of considering infectious aneurysms in patients with septic cavernous sinus syndrome.
- Advanced imaging and selective angiography with potential carotid artery occlusion are vital for managing these complex cases and preventing rupture.
Abstract:
We describe 3 patients who developed infectious aneurysms of the cavernous carotid artery. The aneurysms were due to sphenoidal sinusitis in two patients and due to endocarditis in one. The acute and septic onset of the cavernous sinus syndrome, suggested thrombophlebitis of the cavernous sinus in all 3 patients. The diagnosis was established by magnetic resonance imaging and magnetic resonance angiography. Therapeutic internal carotid artery occlusion was indicated for a fissuration of their aneurysm manifested (n=3) by an episode of epistaxis (n=2) and blood in sphenoid sinus (depicted by MRI) in one case. We discuss the pathophysiology and management of bacterial aneurysms of the cavernous carotid artery. Close clinical and imaging follow-up should be performed for patients under antibiotherapy. Selective angiography with therapeutic occlusion of the carotid artery is discussed in patients with persistence of symptoms or if clinical findings are suggestive of fissuration or if aneurysmal sac diameter increases on follow-up imaging studies.