Xie Tian-Hao, Zhao Wen-Jun, Li Xiao-Long, Hou Yan, Wang Xiong, Zhang Jing, An Xiu-Hua, Liu Li-Tao
Department of General Surgery, Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China.
Department of Ophthalmology, MEM Yinghua Hospital, Baoding 071000, Hebei Province, China.
World J Clin Cases. 2022 May 26;10(15):5051-5056. doi: 10.12998/wjcc.v10.i15.5051.
Carotid blowout syndrome (CBS) refers to rupture of the extracranial carotid artery and its branches; as a severe complication, it usually occurs after surgery or radiotherapy for malignant tumours of the head and neck. We present a case of CBS caused by chronic infection of the external carotid artery (ECA). In this case, we did not find any evidence of head and neck tumours.
A 42-year-old man was referred to the Emergency Department with a complaint of a lump found on the left side of his neck with pain and fever for 4 d. We diagnosed the condition as neck infection with abscess formation based on physical examination, routine blood examination, ultrasound examination and plain computed tomography (CT) and decided to perform emergency surgery. During the operation, 30 mL of grey and smelly pus was drained from the deep surface of the sternocleidomastoid muscle. The second day after the operation, the patient suddenly exhibited a large amount of haemoptysis and incision bleeding. The enhanced CT showed distal occlusion of the left ECA and irregular thickening of the broken ends of the artery encased in an uneven enhancement of soft tissue density. Infected ECA occlusion and rupture were considered. The patient was transferred to a vascular unit for transcatheter ECA embolization and recovered well.
Surgeons need to pay attention to vascular lesions caused by chronic infection that may develop into acute CBS.
颈动脉破裂综合征（CBS）指颅外颈动脉及其分支破裂；作为一种严重并发症，它通常发生在头颈部恶性肿瘤手术或放疗后。我们报告一例由颈外动脉（ECA）慢性感染引起的CBS病例。在该病例中，我们未发现任何头颈部肿瘤的证据。
一名42岁男性因左侧颈部肿块伴疼痛、发热4天被转诊至急诊科。根据体格检查、血常规检查、超声检查及普通计算机断层扫描（CT），我们将病情诊断为颈部感染伴脓肿形成，并决定进行急诊手术。术中，从胸锁乳突肌深面引出30毫升灰白色有臭味的脓液。术后第二天，患者突然出现大量咯血及切口出血。增强CT显示左ECA远端闭塞，动脉断端不规则增厚，包绕软组织密度不均匀强化。考虑为感染性ECA闭塞并破裂。患者被转至血管科行经导管ECA栓塞术，恢复良好。
外科医生需要关注由慢性感染引起的可能发展为急性CBS的血管病变。
