Here, we present a case report on internal carotid artery pseudoaneurysm (ICAP) which highlights a rare but potentially life-threatening complication of transsphenoidal pituitary surgery. A 32-year-old male underwent resection of a pituitary tumor and developed a large cerebrospinal fluid (CSF) leak during surgery, which was reconstructed with a fat graft and nasoseptal flap. Postoperatively, he was recovering well and discharged without complications; however, eight days after surgery he returned with massive epistaxis and hematemesis. This was initially managed with endoscopic exploration, nasal packing, and transfusion of blood products. Imaging revealed a pseudoaneurysm on the right internal carotid artery. The patient was started on aspirin and clopidogrel, and a flow diverter stent was placed without complications. Our case emphasizes the importance of prompt recognition and management of vascular injuries such as an internal carotid pseudoaneurysm after transsphenoidal pituitary surgery to prevent catastrophic outcomes.

Patients presenting with unilateral neck masses is not an uncommon occurrence in an otolaryngology clinic. Especially those with risk factors such as older age and a history of smoking or drinking along with certain characteristics of the mass including rapid growth, immobility, and the presence of other masses elsewhere in the head and neck that can lead to more concerning etiologies such as cancer. However, in those who are younger with non-tender unilateral mobile masses, the differential is wide. We present the case of a 30year-old male who presented with a non-tender left-sided neck mass with no associated or systemic symptoms. Workup including labs for HIV, syphilis, and fungal stains was negative. Pathology demonstrated lymphadenitis with necrotizing granulomas with no recurrence of symptoms after excisional biopsy. The patient continued to have no associated symptoms or recurrent mass thus no further workup was deemed necessary. Although unilateral neck mass and lymphadenitis with necrotizing lymphadenitis have a broad differential diagnosis, this patient's etiology continues to be unknown.