European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2025
Delayed otorrhagia due to Radiation-induced external carotid artery pseudoaneurysm complicated by Temporal bone osteoradionecrosis in nasopharyngeal carcinoma: A case report and literature review.
СтатьяКлинический случайОбзорНазвание и аннотация: Перевод в очереди
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Lo Phoebe Hiu Wai, Kwok Hoi Ming, Cheng Lik Fai, Ma Ka Fai Johnny
Аннотация
BACKGROUND: Pseudoaneurysms following radiotherapy for nasopharyngeal carcinoma (NPC) commonly involve the internal carotid artery (ICA) with epistaxis. External carotid artery (ECA) pseudoaneurysm complicated by temporal bone osteoradionecrosis (ORN) presenting with otorrhagia represents an exceptionally rare, life-threatening complication.
METHODS: We reported a case of delayed otorrhagia due to superficial temporal artery pseudoaneurysm complicated by temporal bone ORN and conducted a literature review of radiation-induced carotid pseudoaneurysms in NPC patients. A PubMed search (2004-2025) was conducted with key words "nasopharyngeal carcinoma", "pseudoaneurysm", "carotid artery" and "radiotherapy" to identify similar cases.
RESULTS: We identified 16 cases of radiation-induced carotid artery pseudoaneurysms in NPC patients, with eight cases demonstrating skull base ORN and two originating from ECA, none showing tumor recurrence. Our case was managed through CT angiogram followed by selective ECA digital subtraction angiography with successful coil embolization.
CONCLUSION: This first-reported case of ECA branch pseudoaneurysm secondary to temporal bone ORN establishes that ORN and soft tissue necrosis predispose to pseudoaneurysm formation. The 19-year latency period highlights the necessity for long-term surveillance in high-risk patients. First-line CT angiography should mandate comprehensive ECA evaluation. Sentinel bleeding episodes with soft tissue necrosis warrant vascular assessment to mitigate pseudoaneurysm rupture risk.
METHODS: We reported a case of delayed otorrhagia due to superficial temporal artery pseudoaneurysm complicated by temporal bone ORN and conducted a literature review of radiation-induced carotid pseudoaneurysms in NPC patients. A PubMed search (2004-2025) was conducted with key words "nasopharyngeal carcinoma", "pseudoaneurysm", "carotid artery" and "radiotherapy" to identify similar cases.
RESULTS: We identified 16 cases of radiation-induced carotid artery pseudoaneurysms in NPC patients, with eight cases demonstrating skull base ORN and two originating from ECA, none showing tumor recurrence. Our case was managed through CT angiogram followed by selective ECA digital subtraction angiography with successful coil embolization.
CONCLUSION: This first-reported case of ECA branch pseudoaneurysm secondary to temporal bone ORN establishes that ORN and soft tissue necrosis predispose to pseudoaneurysm formation. The 19-year latency period highlights the necessity for long-term surveillance in high-risk patients. First-line CT angiography should mandate comprehensive ECA evaluation. Sentinel bleeding episodes with soft tissue necrosis warrant vascular assessment to mitigate pseudoaneurysm rupture risk.