An 83-year-old woman presented to a local clinic with a 2-week history of left neck pain, swelling, and dysphagia. Noncontrast computed tomography (CT) and elevated inflammatory markers raised suspicion of a peritonsillar abscess, prompting her referral to the emergency department (Fig. 1). The patient exhibited a fever of 38 ℃, hoarseness, slurred speech, mild neck tenderness, and wheezing on auscultation and had no history of trauma or prior surgeries. A contrast-enhanced CT of the neck identified a 4.5×3.0×4.8-cm pseudoaneurysm of the left common carotid artery with pharyngolaryngeal edema (Fig. 2). The patient underwent carotid artery repair and was discharged after 2 weeks with no complications.
Common carotid artery pseudoaneurysms are rare, accounting for less than 1% of all aneurysms [1]. Symptoms vary by location, ranging from asymptomatic to a palpable mass, pain, or neurological deficits. As seen in this patient, an aneurysm can compress the pharyngeal muscles, causing dysphagia and tongue muscle weakness [2,3]. The most common causes are neck trauma or surgery, while spontaneous rupture, though rare, can be fatal [4].
Common carotid artery pseudoaneurysm is challenging to diagnose, especially when neurological symptoms are absent and inflammatory markers are elevated, mimicking a more common peritonsillar abscess [5]. Massive hemorrhage has been reported following an incision performed under the misdiagnosis of a peritonsillar abscess [6]. The case highlights the importance of accurate diagnosis using contrast-enhanced CT or Doppler ultrasound, as invasive procedures carry great risks when the nature of the neck mass remains uncertain.
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