Deep Neck Infection Complicated by Internal Carotid Pseudoaneurysm: A Diagnostic and Therapeutic Challenge

Parapharyngeal infections may result in a pseudoaneurysm of the internal carotid artery, a rare but potentially fatal condition. Early recognition and multidisciplinary management are crucial to avoid catastrophic outcomes. We present a case of a twenty-two-year-old man with a parapharyngeal abscess complicated by an internal carotid artery pseudoaneurysm. The patient presented with painful left neck swelling, fever, dysphagia, and hoarseness. Examination revealed oropharyngeal asymmetry, ipsilateral vocal cord paralysis, and shoulder weakness findings consistent with jugular foramen syndrome. Imaging demonstrated a parapharyngeal abscess with a surrounding hematoma encasing the distal internal carotid artery, which appeared aneurysmal and was confirmed as pseudoaneurysm. Despite appropriate antibiotic therapy, the patient's neck pain progressively worsened, and repeat imaging demonstrated enlargement of the lesion. Urgent endovascular coil embolization was successfully performed. The patient was discharged on the second postoperative day and remained neurologically stable at six-month follow-up, with radiological improvement. Carotid pseudoaneurysm secondary to deep neck infection is exceedingly rare. Infection may spread from the parapharyngeal space to the carotid sheath, causing progressive arterial wall erosion. Early identification is crucial, as rupture carries high mortality without intervention. Recent evidence supports endovascular management as a safe and effective alternative to open surgery, particularly for lesions involving the skull base or petrous segment, where surgical exposure is hazardous. This case underscores that deep neck infections presenting with cranial neuropathies or opioid-refractory pain warrant prompt vascular imaging, and that endovascular occlusion represents a safe and effective treatment when collateral circulation is sufficient.