Department of Diagnostic Radiology, Chang Gung Memorial Hospital, College of Medicine and School of Medical Technology, Chang Gung University, Chiayi, Taiwan.
Head Neck. 2011 Mar;33(3):437-40. doi: 10.1002/hed.21305.
Mycotic pseudoaneurysm from the cavernous segment of the internal carotid artery (ICA) secondary to an invasive aspergillus sinusitis is rare. Surgical intervention with ICA ligation is generally accepted for most mycotic aneurysms or pseudoaneurysms. When presented with massive epistaxis due to a fungal aspergillus ICA invasion, mortality rates are high.
We present the case of a 76-year-old man who developed intractable epistaxis due to a mycotic pseudoaneurysm arising from the cavernous segment of the right ICA.
The patient was successfully treated by endovascular embolization at the orifice of the pseudoaneurysm followed by the total ICA trapping technique using electrolytically Guglielmi detachable coils (GDCs) and injection of N-butyl-2-cyanoacrylate (n-BCA). The patient survived for 7 months but eventually died of urosepsis and cardiorespiratory failure.
Endovascular embolization is a feasible and life-saving approach for emergent management of massive intractable epistaxis secondary to a complicated invasive fungal sinusitis.
继发于侵袭性曲霉菌鼻窦炎的颈内动脉（ICA）海绵窦段真菌性假性动脉瘤罕见。大多数真菌性动脉瘤或假性动脉瘤通常采用 ICA 结扎术进行外科干预。当因真菌性曲霉菌 ICA 侵袭而出现大量鼻出血时，死亡率很高。
我们报告了一例 76 岁男性患者，因右侧 ICA 海绵窦段发生真菌性假性动脉瘤而出现难治性鼻出血。
该患者通过假性动脉瘤口进行血管内栓塞治疗成功，随后使用电解可脱卸弹簧圈（GDC）和注射 n-丁基-2-氰基丙烯酸酯（n-BCA）进行总 ICA 阻断技术治疗。该患者存活了 7 个月，但最终死于尿路感染和心肺衰竭。
对于因复杂侵袭性真菌性鼻窦炎引起的大量难治性鼻出血，血管内栓塞是一种可行的救命方法。
