Ruptured Pseudoaneurysm of the Petrous Internal Carotid Artery Caused by Chronic Otitis Media -Case Report-

Abstract

Fig. 1 Axial (A), coronal (B), and sagittal (C) computed tomography scans with contrast medium showing the destroyed petrous bone, the internal carotid artery and the aneurysm (arrow), which are exposed to the right middle ear, and a massive hematoma in the right middle ear. 578Neurol Med Chir (Tokyo) 50, 578¿580, 2010 AbstractA 60-year-old man presented with a rare case of pseudoaneurysm in the petrous internal carotid artery (ICA) caused by chronic otitis media manifesting as right otorrhagia after the earpick procedure. Computed tomography showed the destroyed petrous bone; the ICA and the aneurysm, which were exposed to the right middle ear; and a massive hematoma in the right middle ear. Right carotid angiography revealed a pseudoaneurysm arising from the ICA coursing through the middle ear. Two weeks later, the right ICA was trapped after external carotid artery-middle cerebral artery bypass surgery using a vein graft. A biopsy specimen was obtained from the middle ear and the histological diagnosis was inflammatory disease. Pseudoaneurysm often causes sudden massive aural bleeding. The appropriate management strategy may be exclusion of the pseudoaneurysm with revascularization to avoid leaving foreign material in the infected middle ear.

Cervical–petrous internal carotid artery pseudoaneurysm presenting with otorrhagia treated with endovascular techniques

“…Many of these aneurysms are pseudoaneurysms that arise as a result of trauma,2 9 21 iatrogenic injury,10 15 16 22 23 infection,7 19 radiation,8 11 22 25 or genetic abnormalities, such as fibromuscular dysplasia14 and Ehlers–Danlos syndrome 24. In our case, chronic otitis media is a possible etiology with progressive erosion into the left ICA, although we cannot rule out iatrogenic injury given a history of tympanoplasty.…”

“…CP-ICA aneurysms can present in a variety of different ways, including headache, cranial neuropathies,1 20 23 Horner syndrome,20 transient ischemic attack,4 pulsatile tinnitus,13 hearing loss,6 13 epistaxis,3 4 8 11 13 15 22 and otorrhagia 4 6–8 10 15 19 25. They may also be asymptomatic.…”

Pseudoaneurysm of petrous internal carotid artery presenting as aural polyp

“…Three cases were treated without revascularization and two cases with revascularization. [1,3,5,9,11] One case was treated with coil embolization of the aneurysm dome as done in our patient. [8] We have also done a modified radical mastoidectomy as a definitive procedure.…”

“…Pseudoaneurysms can also manifest as massive otorrhagia or epistaxis following acute rupture, so these rare aneurysms require care. [1][2][3]5,11] Our patient gives history of hearing loss which may be due to chronic otitis media. Aural polyp that occurred as a complication of long-standing chronic otitis media may be attached to the pseudoaneurysm.…”

“…[7,15] Revascularization of the carotid artery using a cervical to middle cerebral artery vein bypass graft may be necessary to provide immediate restoration of high blood flow and to reduce the risk of morbidity and mortality caused by acute ischemic complications. [1,11] Searching through the literature, there are seven reported cases of ruptured pseudoaneurysm caused by chronic otitis media. Three cases were treated without revascularization and two cases with revascularization.…”