Pseudoaneurysm which is also known as a false aneurysm is caused by extravasation of blood from the injured vessel wall which is contained by the surrounding soft tissue. It does not contain any layer of the vessel wall and can expand as more and more blood collects. We are reporting a case of an 18-year-old Indian gentleman who presented with complaint of left neck swelling after being involved in a motor vehicle accident. Examination showed a softly pulsating swelling at the angle of the left mandible. CT angiogram revealed a pseudoaneurysm of a branch of the left facial artery. The pseudoaneurysm was embolized by using histoacryl glue. Pseudoaneurysm should be considered as a differential diagnosis in patients with a pulsatile mass after trauma.
Carotid-cavernous fistula (CCF) is a rare sight and potentially life-threatening disorder arising from an abnormal connection between the carotid artery and the cavernous sinus. It can be classified into direct or indirect according to different arteriovenous shunts. Direct CCF usually has dramatic ocular presentations, whereas indirect CCF has a more insidious course and may be associated with neurologic symptoms in posteriorly draining fistulas.A 61-year-old gentleman presented with five days history of altered behavior and double vision preceding a bulging left eye. Ocular examination showed left eye proptosis, generalized chemosis, total ophthalmoplegia, and raised intra-ocular pressure. Computed tomography angiography (CTA) brain and orbit demonstrated dilated superior ophthalmic vein (SOV) with communication to a tortuous cavernous sinus suggestive of carotid-cavernous fistula (CCF). Digital subtraction angiography (DSA) eventually confirmed the presence of indirect communication between branches of the bilateral external carotid artery (ECA) and left cavernous sinus, which is a type C indirect CCF according to the Barrow classification. Total embolization of left CCF was successfully achieved via transvenous access. A marked reduction of proptosis and intra-ocular pressure was noted following the procedure.Although rare, neuropsychiatric presentation could be a possible presentation of CCF, and treating physicians should be aware of it. A high index of suspicion and prompt diagnosis is crucial in managing this sight and life-threatening condition. Early intervention can improve the prognosis of patients.
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