Infected “Mycotic” Aneurysm of the Common Carotid Artery—A Differential Diagnosis to Tumor of the Neck

Abstract

Introduction: Infected “mycotic” Aneurysm (IA) of the extracranial carotid artery is a rare condition that can be fatal if mistaken for other pathology. An 83-year-old man presented with a mass on the neck initially suspected malignant. Weeks later it grew rapidly and was found to be an IA, thus requiring acute surgery. Via this case report, we discuss diagnostics and approach when diagnosing masses in relation to vessels of the neck not readily explained.Case Report: After diagnostic imaging and clinical assessment an unknown primary tumor of the neck was suspected. Fine needle aspiration was inconclusive. The patient did not present with any signs of infection or neurological symptoms—only discomfort and pain. Approximately two weeks later, the mass grew and the patient became dysphagic, febrile, and confused. Computed tomography angiography revealed an IA of the right common carotid artery. The patient underwent acute surgery consisting of ligation of the internal and external carotid arteries and resection of the internal jugular vein. The pathogen found was E. coli, supposedly from the bladder after surgical intervention due to polyposis.Conclusion: IA is a very rare entity and can have many etiologies. Since it can be fatal, it is necessary to keep IA in mind when diagnosing masses in relation to vessels of the neck. As shown in this case of a E. coli-induced IA, patients can present with atypical symptoms, on diagnostic imaging it can be mistaken for other pathology, and pathogenesis can be unclear.

Mycotic Pseudoaneurysm: Clinical Course, Management and Prognosis

“…Ertapenem was selected due to its very broad spectrum of activity that includes all anaerobes and many aerobic gram-positive and gram-negative organisms [ 4 ]. Eravacycline was used because of the lack of improvement from Ertapenem therapy and the patient had finished the recommended 14-day course [ 5 , 6 ]. Eravacycline has similar coverage as Ertapenem with broad-spectrum activity against Gram-positive cocci and Gram-negative bacilli, and it does not exhibit a loss of antibacterial activity against isolates expressing tetracycline ribosomal protection genes or most tetracycline efflux resistance genes [ 7 , 8 ].…”

“…Mycotic aneurysms are the result of a superimposed infection and most often occur in the femoral artery or abdominal aorta. Like other superinfections, this can be due to bacteremia, local injury with inoculation, spread from neighboring tissues, or septic emboli [3][4][5][6][7]. Typically, the causative organisms involved include Staphylococcus spp, Salmonella spp, and Pseudomonas aeruginosa [8,9].…”

Mycotic internal carotid artery pseudoaneurysm secondary to Mycobacterium tuberculosis

“… 1 , 10 , 11 , 12 , 13 The usual causative organisms of mycotic aneurysms include Staphylococcus aureus , Escherichia coli , and Salmonella species, although Streptococcus and Klebsiella species have also been implicated. 1 , 2 , 3 , 14 , 15 , 16 Although historically more prevalent, M tuberculosis has been a rare causative pathogen in the formation of mycotic carotid aneurysms for the last century, with only four previous cases reported in literature. 2 , 3 , 17 Mycobacterial mycotic aneurysms in the carotid artery have also been described after bacillus Calmette-Guerin therapy for bladder cancer.…”

“…Mycotic carotid aneurysms are associated with high morbidity and mortality, with potential complications, including rupture and fatal hemorrhage, fistulation, airway compromise, stroke, cranial nerve palsies, and intracerebral abscesses by hematogenous metastases. 1 , 2 , 10 , 16 , 18 , 19 , 21 In patients with an active suppurative infection in the neck, airway edema and compromise may be encountered; therefore, the careful induction of anesthesia and airway management are mandatory. The limited reports of mycotic carotid artery pseudoaneurysms in the literature uniformly support the combined strategy of antibiotic therapy and prompt surgical management.…”

A Pulsating Internal Carotid Artery Aneurysm in Pharynx: An Airway Challenge

“…Complications include rupture, cataclysmic bleeding, airway compromise, stroke, and cranial nerve palsies. 2,3 In patients with intraoral or intrapharyngeal extension, airway edema and compromise can occur. Hence, anticipation, proper evaluation, and preparation are mandated in such cases.…”