Fig 1 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
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Computed tomography (CT) angiogram of the carotid arteries in (A) axial, (B) sagittal, and (C) oblique threedimensional vessel volume rendered image projections, demonstrating a bilobed aneurysm arising from the proximal right internal carotid artery (ICA) and the carotid bulb, just distal to the bifurcation of the right common carotid artery (yellow arrows). Note the area of hypoattenuation surrounding the right ICA aneurysm, measuring 4.3 Â 3.5 cm, consistent with a collection.
Source publication
Mycobacterium tuberculosis is a rare causative agent for mycotic aneurysms of the extra-cranial carotid arteries. We describe a case of acute mycotic pseudoaneurysm and abscess in the right proximal internal carotid artery in close proximity to the carotid bifurcation, and subsequent management with antibiotic therapy, surgical debridement and rese...
Context in source publication
Context 1
... tomography (CT) angiography of the aortic arch, cervical vessels, and head revealed a 10 Â 9 mm bilobed pseudoaneurysm arising from the origin of the right ICA, and an overlying 4 Â 3 cm collection (Fig 1). These findings were confirmed with duplex ultrasound and contrast-enhanced magnetic resonance angiography, which identified features of an extensive abscess originating from the right carotid space and extending into the adjacent soft tissues (Fig 2). ...
Citations
... Atherosclerotic degeneration, traumatic injury, radiation, and local infection have been suggested as potential causes [2][3][4][5]7]. Increasing evidence in the literature points to the possible association between infection and ECAA [8][9][10][11]. Several reports implicated infections associated with the oro-dental cavity [12,13]. ...
Aim: To assess the prevalence of acute periapical abscesses (PAs) in patients with a history of extracranial carotid artery aneurysms (ECAA). Materials and methods : History of acute PAs and ECAA diagnosis was retrieved by searching the appropriate query in the database. All cases were diagnosed for acute PAs by calibrated dentists for patients admitted to urgent care. The odds ratio (OR) for the prevalence of acute PAs and its association with history of ECAA were then calculated. Results : The prevalence of acute PAs in patients with a history ECAA was significantly higher as compared to the general hospital patient population ( p < 0.0001). The OR was 5.5. Females were more affected than males by 1.7 folds ( p < 0.001). Whites were more affected than African Americans by 1.6 folds ( p < 0.00001). Conclusions : The high prevalence of acute PAs in patients with a history of ECAA may suggest an association between these two conditions warranting a thorough medical examination.
Introduction
Infective native extracranial carotid artery aneurysms are rare, and their management is variable due to a lack of evidence assessing outcomes.
Methods
We performed a systematic literature review following PRISMA guidelines to identify all reported cases of infective native extracranial carotid artery aneurysms between January 1970 and March 2021.
Results
This study identified 193 infective native aneurysms of the extracranial carotid artery from 154 sources. Patients were predominantly male (71.4%), and age ranged from 6 months to 89 years old. The most common presenting features were a neck mass and fever, but also included haemorrhage, respiratory distress and neurological symptoms. Most aneurysms were located in the internal carotid artery (47.4%). Staphylococcus (23.3%) was the most commonly identified causative pathogen, followed by Mycobacterium tuberculosis (20.9%). Most appeared to become infected by direct local spread. Treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41 cases. In four cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In five cases there was antibiotic treatment alone. In the open surgery treated group, the complication rate was 20.8% compared to 13.2% in the endovascular group. Mortality rate was 5.6%.
Conclusion
Our review identified 193 cases of infective native extracranial carotid artery aneurysms. Direct local spread of a staphylococcus infection was the commonest cause. Endovascular management was associated with fewer early complications than open surgical management.
