Imaging of Carotid Blowout Syndrome in a Patient with Nasopharyngeal Carcinoma After Radiation Therapy.

INTRODUCTION

This case highlights the rare but life-threatening complication of carotid blowout syndrome (CBS) after radiotherapy for nasopharyngeal carcinoma (NPC). It is characterized by rupture of the carotid artery, often occurring months or years after treatment. Early diagnosis and timely intervention are essential to improve clinical outcomes.

CASE PRESENTATION: A 45-year-old woman with NPC developed recurrent epistaxis 31 months after chemoradiotherapy. MRI and MRA ruled out tumor recurrence. High-resolution vessel wall imaging (VWI) revealed eccentric thickening, irregular enhancement, and a pseudoaneurysm in the lacerum segment of the left internal carotid artery (ICA), which was confirmed by CTA and DSA. The patient underwent embolization and remained stable at 1-year follow-up.

CONCLUSION

This case underscores the value of VWI in detecting CBS-related vascular changes. Imaging is crucial for early diagnosis and timely intervention in high-risk patients with NPC who have undergone radiotherapy.