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Haematemesis from distal extracranial carotid aneurysms. Case report and literature review
Insights
A child
Area of Science:
- Vascular Surgery
- Pediatric Neurology
- Interventional Radiology
Background:
- Spontaneous extracranial internal carotid artery (ICA) aneurysms are rare in children.
- Cervical ICA aneurysms can present with life-threatening hemorrhage.
- Diagnosis can be challenging, especially without a palpable pulsatile mass.
Observation:
- A 5-year-old boy presented with severe upper gastrointestinal bleeding due to a ruptured high cervical internal carotid artery aneurysm.
- The aneurysm was not associated with a pulsatile neck mass, complicating initial diagnosis.
- Emergency surgical intervention was required to control the bleeding.
Findings:
- Successful emergency trap ligation of the distal internal carotid artery (ICA) in the neck controlled the hemorrhage.
- The patient experienced an excellent recovery with no neurological deficits.
- Seven years post-intervention, the patient presented with only a resolved Horner's syndrome.
Implications:
- Prompt diagnosis and surgical management are crucial for life-threatening extracranial carotid artery aneurysms in children.
- Extracranial carotid artery aneurysms can present insidiously, necessitating high clinical suspicion.
- Surgical intervention, such as trap ligation, can lead to favorable long-term outcomes in pediatric patients.
Abstract:
A 5-year-old white boy presented with life-threatening haematemesis from spontaneous rupture of an aneurysm of the high cervical internal carotid artery (ICA). The haemorrhage was controlled by emergency trap ligation of the distal ICA in the neck. The child made an excellent recovery and 7 years later has no neurologic deficit other than an Horner's syndrome. The diagnosis of an extracranial carotid artery aneurysm without a pulsatile lump may be very deceptive.