Sridharan Radhika, Low Soo Fin, Mohd Mohd Redzuan, Kew Thean Yean
Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaakob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia.
Singapore Med J. 2014 Oct;55(10):e165-8. doi: 10.11622/smedj.2014148.
Epistaxis is commonly encountered in otorhinolaryngologic practice. However, severe and recurrent epistaxis is rarely seen, especially that originating from a pseudoaneurysm of the intracavernous internal carotid artery (ICA). We herein present the case of a 32-year-old man who was involved in a motor vehicle accident and subsequently developed recurrent episodes of profuse epistaxis for the next three months, which required blood transfusion and nasal packing to control the bleeding. Computed tomography angiography revealed a large intracavernous ICA pseudoaneurysm measuring 1.7 cm × 1.2 cm × 1.0 cm. The patient underwent emergent four-vessel angiography and coil embolisation and was discharged one week later without any episode of bleeding. He remained asymptomatic after three-month and one‑year intervals. This case report highlights a large intracavernous ICA pseudoaneurysm as a rare cause of epistaxis, which requires a high index of suspicion in the right clinical setting and emergent endovascular treatment to prevent mortality.
鼻出血在耳鼻咽喉科临床实践中较为常见。然而，严重且复发性鼻出血较为少见，尤其是源自海绵窦段颈内动脉（ICA）假性动脉瘤的鼻出血。我们在此报告一例32岁男性患者，该患者曾遭遇机动车事故，随后在接下来的三个月内反复出现大量鼻出血，需要输血及鼻腔填塞来控制出血。计算机断层血管造影显示一个大小为1.7 cm×1.2 cm×1.0 cm的巨大海绵窦段ICA假性动脉瘤。患者接受了急诊四血管造影及弹簧圈栓塞治疗，一周后出院，未再发生出血事件。在三个月及一年的随访期后，他仍无症状。本病例报告强调了巨大海绵窦段ICA假性动脉瘤是鼻出血的罕见原因，在正确的临床情况下需要高度怀疑，并需急诊血管内治疗以预防死亡。
