Unexpected diagnosis of a neck lump

Abstract

A case report of a patient with a right‐sided neck lump initially presenting to his dentist who was subsequently diagnosed with a rare mycotic carotid artery aneurysm. Clinical examination in York out‐patient department led to a high index of suspicion of metastatic squamous cell cancer (SCC). A malignant process was suspected due to the combination of a fixed level 2 neck lump, otalgia and vocal cord palsy. However, a differential diagnosis of an aneurysm became more likely following an MRI scan. The patient subsequently underwent urgent debridement of the carotid artery aneurysm and ligation of the internal carotid artery. Mycotic aneurysms involving the carotid arteries are rare with only around 20 reported cases every decade with a small number of cases reporting dental infection as a potential cause. The definitive diagnosis of a mycotic aneurysm demonstrates how similar the presenting features of a metastatic SCC can be to that of a carotid aneurysm. Despite the low incidence, the importance of considering an aneurysm in the differential diagnosis of neck lumps is highlighted due to possible catastrophic consequences.[Correction statement added on 14 August 2019 after first online publication: The first two sentences of Abstract section were found to be similar and has been updated this version for clarity]