Sphenopalatine artery pseudoaneurysm masquerading as a second primary maxillary carcinoma

Area of Science:

• Otolaryngology
• Interventional Radiology
• Oncology

Background:

• Maxillary sinus carcinomas are typically diagnosed at advanced stages.
• Recurrence as a contralateral primary malignancy is exceptionally rare.
• Sphenopalatine artery (SPA) pseudoaneurysms can present with epistaxis.

Observation:

• A 90-year-old male with prior right maxillary sinus cancer presented with recurrent epistaxis.
• Radiology revealed a left maxillary sinus mass suspicious for malignancy.
• Intraoperative bleeding necessitated a change in management strategy.

Findings:

• Diagnostic angiography identified a sphenopalatine artery pseudoaneurysm.
• The pseudoaneurysm was successfully treated with endovascular embolization.
• This condition mimicked a secondary maxillary sinus malignancy.

Implications:

• Sphenopalatine artery pseudoaneurysms are a critical differential diagnosis for recurrent epistaxis in patients with sinonasal cancer history.
• Endovascular embolization offers a successful management option for SPA pseudoaneurysms.
• Accurate diagnosis prevents unnecessary aggressive surgical intervention for sinonasal masses.