Carotid blowout syndrome

Area of Science:

• Vascular Surgery
• Emergency Medicine
• Head and Neck Oncology

Background:

• Carotid blowout syndrome (CBS) is a life-threatening condition involving carotid artery rupture, often secondary to head and neck cancer treatments.
• It presents a significant clinical challenge due to potential for massive hemorrhage and high mortality.
• Understanding CBS is critical for timely diagnosis and management in emergency settings.

Observation:

• A patient without prior head or neck cancer history presented with a painless, enlarging neck mass.
• The mass rapidly caused acute airway obstruction during diagnostic imaging, requiring emergency cricothyrotomy.
• This unusual presentation preceded significant carotid artery bleeding.

Findings:

• The patient required four endovascular procedures to control recurrent bleeding from the carotid artery.
• Management of bleeding led to a neurological complication: right middle cerebral artery infarction.
• The case underscores the unpredictable nature of CBS, even in the absence of typical risk factors.

Implications:

• This case expands the known clinical spectrum of carotid blowout syndrome.
• It emphasizes the need for prompt airway management and aggressive endovascular strategies in suspected CBS.
• Highlights the potential for severe neurological complications following interventions for carotid artery rupture.