Internal Carotid Artery Aneurysm Mimicking Peritonsillar Abscess

Area of Science:

• Vascular Surgery
• Neurology
• Radiology

Background:

• Extracranial internal carotid artery aneurysms (EICAA) are rare vascular lesions.
• Patients often present with neurological deficits due to compromised cerebral blood flow or cranial nerve compression.
• EICAA can manifest as an asymptomatic pulsatile neck mass.

Purpose of the Study:

• To report a unique case of a large atherosclerotic EICAA in an elderly female.
• To emphasize the diagnostic challenges and imaging modalities used for EICAA.
• To discuss the clinical presentation and management considerations for EICAA.

Main Methods:

• Case presentation of an 84-year-old female with a parapharyngeal mass.
• Physical examination findings including a nonpulsatile mass and mucosal erythema.
• Diagnostic imaging including Duplex Doppler Ultrasonography and Computed Tomography (CT) to characterize the aneurysm.

Main Results:

• A large (63 × 55 × 88 mm) atherosclerotic aneurysm of the right internal carotid artery was identified.
• The aneurysm extended from the skull base to the mandibular angle.
• The patient had a history of hypertension, ischemic stroke, and recent upper respiratory infection.

Conclusions:

• EICAA, though uncommon, should be considered in the differential diagnosis of neck masses, especially in patients with cardiovascular risk factors.
• Advanced imaging like CT angiography is crucial for accurate diagnosis and surgical planning.
• Prompt diagnosis and management are essential to prevent neurological complications.