Coil Embolization of a Pseudoaneurysm of the Petrous Internal Carotid Artery Presenting with Otorrhagia: A Case Report and Review of the Literature

Abstract

: Otorrhagia is not a common manifestation of petrous internal carotid artery (ICA) aneurysm. Besides idiopathic cases, different etiologies, including trauma, infection, and radiation, have been suggested for petrous ICA aneurysms/pseudoaneurysms. However, there is limited experience in the management of this rare aneurysm/pseudoaneurysm with coil embolization. A 58-year-old man, who was a known case of chronic otitis media, was referred from the otorhinolaryngology ward with intractable bleeding from the right ear. A pseudoaneurysmal lesion (7 mm × 5 mm) was detected in the petrous segment of the internal carotid artery. The patient underwent coil embolization with no complications. To the best of our knowledge, this is the first case of petrous ICA pseudoaneurysm, presenting with only intractable otorrhagia. The patient was successfully treated with coil embolization, with no need for further interventions. Besides, a review of petrous ICA aneurysms or pseudoaneurysms presenting with otorrhagia was performed.

Fatal Cataclysmic Otorrhagia and Epistaxis Due to a Ruptured Aneurysm of the Petrous Internal Carotid Artery: A Case Report

“…Massive otorrhagia has limited differential diagnoses, such as glomus tumors and vascular lesions, including uncovered high jugular bulbs, ICA aneurysmal lesions, hemangioma, arteriovenous malformations [9], and persistent stapedial artery [10].…”

“…However, since access to the petrous segment of the ICA is challenging, open surgery is not the primary intervention. Today, minimally invasive endovascular techniques, such as coil embolization and stenting, have replaced open surgery [9].…”