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Internal carotid artery pseudoaneurysm with life-threatening epistaxis as a complication of deep neck space infection

Paulo Sérgio Lucas da Silva1, Daniel Reis Waisberg

  • 1Pediatric Intensive Care Unit, Hospital Brigadeiro, São Paulo, Brazil. psls.nat@terra.com.br

Pediatric Emergency Care
|May 7, 2011
PubMed

Insights

A rare complication of deep neck infections in children, pseudoaneurysms of the internal carotid artery can cause severe epistaxis. Endovascular treatment successfully excluded the pseudoaneurysm, leading to recovery.

Area of Science:

  • Vascular Surgery
  • Pediatric Infectious Diseases
  • Interventional Radiology

Background:

  • Deep neck space infections in children are uncommon but can lead to severe complications.
  • Pseudoaneurysms of the cervical internal carotid artery are a rare, potentially fatal sequela of such infections.
  • These complications are associated with high mortality and morbidity rates.

Observation:

  • A 3-year-old boy presented with massive epistaxis 45 days post-peritonsillar abscess (deep neck infection).
  • During attempted nasopharyngeal packing, the patient experienced cardiac arrest, prompting further investigation.
  • Intra-arterial angiography revealed a large pseudoaneurysm of the cervical internal carotid artery.

Findings:

  • Endovascular treatment using detachable balloons was performed to exclude the pseudoaneurysm.
  • The procedure successfully achieved complete exclusion of the pseudoaneurysm.
  • The child recovered without sensory or cognitive deficits, though with mild left hemiparesis.

Implications:

  • Delayed massive epistaxis can indicate a pseudoaneurysm following deep neck infection in children.
  • Prompt investigation of regional blood vessels is crucial in cases of hypovolemic shock.
  • High clinical suspicion and timely, definitive endovascular treatment are essential for favorable outcomes.

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