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Rapid development of bilateral internal carotid artery aneurysm from sphenoid sinus aspergillosis

W R Wilson, A Hawrych, W Olan

    Skull Base Surgery
    |December 16, 2006
    PubMed

    Insights

    Fungal infections of the sphenoid sinuses can rapidly cause internal carotid artery aneurysms, even in immunocompromised patients. Sinus surgeons must be aware of this potentially devastating complication.

    Area of Science:

    • Otolaryngology
    • Vascular Surgery
    • Infectious Diseases

    Background:

    • Immunocompromised patients, particularly those on renal dialysis and high-dose steroids, are susceptible to opportunistic infections.
    • Fungal sinusitis, specifically aspergillosis, can lead to severe complications.
    • Internal carotid artery aneurysms pose a significant risk of rupture and neurological damage.

    Observation:

    • A case report detailing a patient with suspected temporal arteritis who developed rapid mycotic aneurysms of the internal carotid arteries.
    • Initial imaging (MRA, CT) suggested fungal infection of the sphenoid sinuses but did not reveal aneurysms.
    • During sphenoidotomy, an aneurysm of the left internal carotid artery was discovered, followed by the identification of a second, newly formed aneurysm on the right.

    Findings:

    • The case demonstrates the potential for rapid development of mycotic aneurysms from fungal sphenoid sinusitis.
    • Aspergillosis of the sphenoid sinuses was confirmed as the underlying fungal infection.
    • The aneurysms directly involved and filled the sphenoid sinuses, highlighting the anatomical proximity and risk.

    Implications:

    • Highlights the critical need for sinus surgeons to consider and investigate mycotic aneurysms in patients with fungal sinusitis, especially immunocompromised individuals.
    • Emphasizes the importance of prompt diagnosis and aggressive management of fungal sinus infections to prevent life-threatening vascular complications.
    • Suggests that rapid vascular imaging may be warranted in cases of severe or invasive fungal sinusitis to rule out associated aneurysms.

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