Janipour Masoud, Yousefi Alireza, Soltani Sajjad, Nadgaran Mahsan, Bagheri Milad, Yousufzai Shayan
Department of Otolaryngology, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Otolaryngology, Head and neck Surgery Department, Khalili Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Int J Surg Case Rep. 2025 May;130:111251. doi: 10.1016/j.ijscr.2025.111251. Epub 2025 Apr 3.
Deep neck space infections, particularly peritonsillar abscesses, can lead to severe complications in pediatric patients, including vascular injuries such as internal carotid artery (ICA) aneurysms. Although rare, these complications require prompt recognition and intervention to prevent life-threatening outcomes.
We report a case of a 14-year-old male presenting with a rapidly enlarging left-sided neck bulge, dysphagia, and fever persisting for two weeks. Initial examination suggested a peritonsillar abscess, but surgical drainage resulted in arterial bleeding. Imaging revealed over 90 % stenosis of the left ICA with an associated aneurysm. The patient underwent angioplasty and hematoma evacuation, followed by a multidisciplinary approach to manage complications, including femoral pseudoaneurysms.
Internal carotid artery aneurysms are rare, especially in pediatric patients, and are often associated with deep neck infections. This case highlights the importance of advanced imaging and a multidisciplinary approach to diagnose and manage such complications. The patient's congenital hypoplastic posterior communicating artery may have exacerbated the risk of ischemic events during ICA compromise.
This case underscores the critical need for vigilance in diagnosing and managing vascular complications arising from deep neck infections in pediatric patients. Early intervention and a collaborative healthcare approach are essential to prevent severe outcomes, including life-threatening hemorrhage. The findings emphasize the importance of preoperative vascular imaging in atypical presentations of neck infections to mitigate iatrogenic risks.
颈部深部间隙感染，尤其是扁桃体周围脓肿，可导致儿科患者出现严重并发症，包括诸如颈内动脉（ICA）动脉瘤等血管损伤。尽管此类并发症罕见，但需要迅速识别并进行干预，以防止危及生命的后果。
我们报告一例14岁男性患者，其左侧颈部肿块迅速增大，伴有吞咽困难和持续两周的发热。初步检查提示为扁桃体周围脓肿，但手术引流导致动脉出血。影像学检查显示左侧颈内动脉狭窄超过90%并伴有动脉瘤。患者接受了血管成形术和血肿清除术，随后采用多学科方法处理并发症，包括股部假性动脉瘤。
颈内动脉动脉瘤罕见，尤其是在儿科患者中，且常与颈部深部感染相关。该病例突出了先进影像学检查以及多学科方法在诊断和处理此类并发症方面的重要性。患者先天性后交通动脉发育不全可能在颈内动脉受压期间加剧了缺血事件的风险。
该病例强调了在诊断和处理儿科患者颈部深部感染引起的血管并发症时保持警惕的迫切需求。早期干预和协作性医疗方法对于预防严重后果（包括危及生命的出血）至关重要。研究结果强调了术前血管成像在颈部感染非典型表现中的重要性，以降低医源性风险。
