Peritonsillar abscess complicated by internal carotid artery aneurysm in a pediatric patient with congenital hypoplastic posterior communicating artery: A case report.

BACKGROUND

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.

CASE PRESENTATION

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.

DISCUSSION

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.

CONCLUSION

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.