Marsot-Dupuch K, Riachi S, Berthet K, Azizi L
Service de Radiologie, Hôpital Saint-Antoine, 184, rue du Faubourg St-Antoine, 75012 Paris.
J Radiol. 2000 Aug;81(8):891-8.
We describe 3 patients who developed infectious aneurysms of the cavernous carotid artery. The aneurysms were due to sphenoidal sinusitis in two patients and due to endocarditis in one. The acute and septic onset of the cavernous sinus syndrome, suggested thrombophlebitis of the cavernous sinus in all 3 patients. The diagnosis was established by magnetic resonance imaging and magnetic resonance angiography. Therapeutic internal carotid artery occlusion was indicated for a fissuration of their aneurysm manifested (n=3) by an episode of epistaxis (n=2) and blood in sphenoid sinus (depicted by MRI) in one case. We discuss the pathophysiology and management of bacterial aneurysms of the cavernous carotid artery. Close clinical and imaging follow-up should be performed for patients under antibiotherapy. Selective angiography with therapeutic occlusion of the carotid artery is discussed in patients with persistence of symptoms or if clinical findings are suggestive of fissuration or if aneurysmal sac diameter increases on follow-up imaging studies.
我们描述了3例发生海绵窦段颈内动脉感染性动脉瘤的患者。其中2例患者的动脉瘤由蝶窦炎引起，1例由心内膜炎引起。所有3例患者均出现海绵窦综合征的急性和感染性发作，提示海绵窦血栓性静脉炎。诊断通过磁共振成像和磁共振血管造影确定。对于表现为动脉瘤破裂（n = 3）的患者，其中2例出现鼻出血，1例在蝶窦内发现血液（磁共振成像显示），均提示需要进行治疗性颈内动脉闭塞。我们讨论了海绵窦段颈内动脉细菌性动脉瘤的病理生理学和治疗方法。接受抗生素治疗的患者应进行密切的临床和影像学随访。对于症状持续存在、临床检查提示动脉瘤破裂或随访影像学检查显示动脉瘤囊直径增大的患者，讨论了选择性血管造影及颈动脉治疗性闭塞的方法。
