Mykotisches Aneurysma der Arteria carotis interna

Abstract

The detection of aneurysms of the internal carotid artery due to acute or chronic neck infections seems to be a rather rarely event. However, if aneurysms or pseudoaneurysms of the neck region occur, than mostly by bleeding complication or unclear significant soft tissue swelling. The case of a patient is reported, who underwent an abscess tonsillectomy. The intraoperative situation of the right tonsillar fossa was found to show suspicious pulsations under the scarred and inflamed peritonsillar tissue layer. The postoperative performed intraarterial angiography verified the diagnosis of the aneurysm of the internal carotid artery nearby the tonsillar fossa. The diagnosis mycotic aneurysm has been concluded by the long lasting tonsillitis history with one further peritonillar abscess in the past, intraoperative and histological signs of peritonsillitis and the the result of an intraarterial angiography carried through 10 years ago without any clue to aneurysm. A bleeding complication did not occur in this case. The patient went into the care of vascular surgeons with the indication to perform a stent application.

Complications of peritonsillar abscess

“…In addition to symptoms of PTA, some patients presented with intermittent severe hemorrhage (n = 2) and anisocoria (n = 1) [ 105 , 106 ]. In two cases, a bleeding pseudoaneurysm developed 35–45 days after PTA drainage [ 107 , 109 ], while the PTA and the carotid artery lesion were diagnosed simultaneously in five cases [ 105 , 106 , 108 , 110 , 111 ]. Four patients were children (3–15 years of age) and two patients were elderly (65 and 95 years of age, respectively).…”

“…The bacterial findings in PTA specimens were only described in two cases [ 109 , 111 ]: streptococcus Group A (n = 1) and VGS (n = 1). Ligation or embolization of the internal carotid artery was carried out in all but one patient (who underwent stenting) [ 108 ]. All patients survived, but sequelae were described in three cases: Horners syndrome (n = 3) and discrete contralateral neurological deficit (n = 1) [ 106 , 109 , 110 ].…”