Internal Carotid Artery Aneurysm Mimicking Peritonsillar Abscess

Abstract

The extracranial internal carotid artery aneurysm (EICAA) is an uncommon arterial lesion. Patients typically present with neurologic symptoms resulting from impaired cerebral perfusion and compression symptoms of cranial nerves. Often EICAA presents as a pulsatile neck mass, which is otherwise asymptomatic. We present a case of an 84-year-old female, who was initially referred to the Emergency Department for Otolaryngology with suspected peritonsillar abscess. The patient had a history of recent upper airway infection and cardiovascular comorbidities, including hypertension and ischaemic stroke complicated by extensive neurologic deficits. Physical examination revealed a compact, nonpulsatile mass in the lateral parapharyngeal space and local erythema of the mucosa. Duplex Doppler Ultrasonography and Computed Tomography revealed an atherosclerotic aneurysm of the right internal carotid artery, measuring 63 × 55 × 88 mm, stretching from the skull base to the angle of the mandible.

Vascular Complications of Parapharyngeal Abscesses

“…The two main vascular complications reported in the literature are extrinsic carotid artery stenosis due to compression by the abscess and pseudoaneurysm [14,15]. Internal carotid artery aneurysms can mimic peritonsillar abscess and incision drainage can be fatal [16]. Infectious arteritis of the internal carotid artery with pending rupture is rare [17].…”

Carotid artery aneurysm associated with Marfan Syndrome: A case report

“…We have to cite also mycotic 10 aneurysms, occasionally caused by infected embolism in a patient affected by bacterial endocarditis or more frequently by cellulitis or peritonsillar 11 or mastoid abscess.…”