Ruptured pseudoaneurysm of the petrous internal carotid artery caused by chronic otitis media.

A 60-year-old man presented with a rare case of pseudoaneurysm in the petrous internal carotid artery (ICA) caused by chronic otitis media manifesting as right otorrhagia after the earpick procedure. Computed tomography showed the destroyed petrous bone; the ICA and the aneurysm, which were exposed to the right middle ear; and a massive hematoma in the right middle ear. Right carotid angiography revealed a pseudoaneurysm arising from the ICA coursing through the middle ear. Two weeks later, the right ICA was trapped after external carotid artery-middle cerebral artery bypass surgery using a vein graft. A biopsy specimen was obtained from the middle ear and the histological diagnosis was inflammatory disease. Pseudoaneurysm often causes sudden massive aural bleeding. The appropriate management strategy may be exclusion of the pseudoaneurysm with revascularization to avoid leaving foreign material in the infected middle ear.