Extracranial Pseudoaneurysm Arising from the Internal Carotid Artery.

An 81-year-old woman complained of swelling of her left neck with pulsation and systolic bruit, which developing within a period of a few months (Picture 1). Ultrasound showed a ballooning structure with blood flow from the left internal carotid artery (ICA), which suggested a pseudoaneurysm (size: 5.8×5.0×5.3 cm) arising from the left ICA through a fistula in the arterial wall (Picture 2). Subsequent angiography confirmed this diagnosis (Picture 3, 4). To prevent a rupture of the pseudoaneurysm, cerebral emboli, and other fatal events, a proximal site of the left internal carotid artery was surgically ligated to block the blood supply through the fistula. In most cases, pseudoaneurysms have a traumatic or surgical (iatrogenic) etiology. Degenerative atherosclerosis may also be involved in the development of pseudoaneurysms in cases in which no relevant preceding event can be identified, such as the present case (1). Although there are many possible causes of swelling of the neck, prompt surgical or endovascular management is required for these potentially fatal vascular lesions (2).

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The author states that he has no Conflict of Interest (COI).