Intracavernous internal carotid artery pseudoaneurysm

Area of Science:

• Otorhinolaryngology
• Vascular Surgery
• Neurology

Background:

• Epistaxis is a common otolaryngologic complaint.
• Severe and recurrent epistaxis is uncommon.
• Pseudoaneurysms of the intracavernous internal carotid artery (ICA) are a rare cause of epistaxis.

Observation:

• A 32-year-old male presented with recurrent, profuse epistaxis post-motor vehicle accident.
• Epistaxis necessitated blood transfusion and nasal packing.
• Computed tomography angiography identified a large (1.7 cm × 1.2 cm × 1.0 cm) intracavernous ICA pseudoaneurysm.

Findings:

• The patient underwent emergent four-vessel angiography and successful coil embolization of the pseudoaneurysm.
• The patient was discharged within a week and remained asymptomatic at three-month and one-year follow-ups.
• This case highlights a large intracavernous ICA pseudoaneurysm as a rare etiology of severe epistaxis.

Implications:

• A high index of suspicion is necessary for diagnosing intracavernous ICA pseudoaneurysms in patients with severe epistaxis.
• Emergent endovascular treatment is critical for managing this condition and preventing potentially fatal hemorrhage.
• This case underscores the importance of advanced imaging and endovascular techniques in managing rare vascular causes of epistaxis.