Common carotid arterial pseudoaneurysm mistaken for peritonsillar abscess
Article information
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.
A noncontrast computed tomography scan of the neck led to a misdiagnosis of a peritonsillar abscess. Arrow indicates a round, isodense peritonsillar mass.
Contrast-enhanced computed tomography scan of the neck. (A) Coronal view. (B) Transverse view. Arrows indicate the common carotid pseudoaneurysm, which, due to its mass effect, compresses the airway and is accompanied by surrounding edema.
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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Ethics statement
Informed consent for publication of the research details and clinical images was obtained from the patient.
Author contributions
Conceptualization: JEK; Investigation: all authors; Supervision: JEK; Writing–original draft: SK; Writing–review & Editing: JEK. All authors read and approved the final manuscript.
Conflicts of interest
The authors have no conflicts of interest to declare.
Funding
The authors received no financial support for this study.
Data availability
Data sharing is not applicable as no new data were created or analyzed in this study.
References
Article information Continued
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Capsule Summary
What is already known
Common carotid artery pseudoaneurysm is an exceptionally rare condition. It is reported only in a limited number of cases and often is misdiagnosed as a peritonsillar abscess.
What is new in the current study
When the nature of a neck mass remains uncertain, contrast-enhanced computed tomography or Doppler ultrasound should be performed to ensure an accurate diagnosis before proceeding with invasive procedures.