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Infectious arteritis of the internal carotid artery complicating retropharyngeal abscess
Q Lisan1, H Tran1, B Verillaud1
1Service d'otorhinolaryngologie et chirurgie cervicofaciale, hôpital Lariboisière, AP-HP, université Paris 7 Denis-Diderot, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
Insights
Retropharyngeal abscess can lead to rare but dangerous internal carotid artery infectious arteritis in adults. Prompt diagnosis and aggressive treatment, including endovascular occlusion, are crucial to prevent severe complications.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Neuroradiology
Background:
- Retropharyngeal abscesses, though common in children, also occur in adults.
- Vascular complications include compression and pseudoaneurysm, with infectious arteritis being exceptionally rare.
- Infectious arteritis of the internal carotid artery is a seldom-seen complication of deep neck infections.
Observation:
- A case of a retropharyngeal abscess in an adult woman was complicated by infectious arteritis of the internal carotid artery.
- The patient underwent endovascular occlusion of the internal carotid artery and abscess drainage.
- Combined antibiotic and anticoagulant therapy was administered.
Findings:
- The patient experienced no neurological sequelae following treatment.
- Follow-up MRI confirmed no vascular or neurological complications.
- This represents the first reported instance of infectious arteritis of the internal carotid artery complicating a retropharyngeal abscess.
Implications:
- Emphasizes the need for vigilant imaging review in deep neck space abscesses to identify vascular involvement.
- Aggressive management is vital due to the high risk of arterial rupture or septic embolism.
- Highlights a rare but critical complication requiring prompt and specialized intervention.
Introduction:
Retropharyngeal abscess is a well-known entity in children, but can also occur in adults. The two main vascular complications are vascular compression and pseudoaneurysm, while infectious arteritis of the internal carotid artery is exceptional.
Case Report:
The authors describe a case of a retropharyngeal abscess in an adult woman complicated by infectious arteritis of the internal carotid artery. This rare complication was treated by endovascular occlusion of the internal carotid artery and incision and drainage of the abscess in combination with antibiotic and anticoagulant therapy. The patient did not present any neurological sequelae and follow-up MRI did not reveal any signs of vascular or neurological complications.
Discussion:
This case highlights the importance of thorough examination of imaging performed in the context of deep neck space abscess to detect signs of vascular involvement. Treatment must be aggressive in view of the life-threatening risk of arterial rupture or septic embolism. This is the first reported case of infectious arteritis involving the internal carotid artery complicating retropharyngeal abscess.
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