Nontraumatic and postirradiated intracavernous carotid hemorrhage: an unusual case of epistaxis and review of the literature

Wang, Jing-Jing; Wang, Yong; Chang, Po-Hung; Lee, Ta-Jen; Wang, De-Hui

doi:10.1016/j.amjoto.2009.10.006

« Previous Next »American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 32, Issue 2 , Pages 162-164, March 2011

Nontraumatic and postirradiated intracavernous carotid hemorrhage: an unusual case of epistaxis and review of the literature

Jing-Jing Wang, MD
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China
Yong Wang, MD
- Department of Neurosurgery, Jiao Tong University, Shanghai, PR China
Po-Hung Chang, MD
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Ta-Jen Lee, MD
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
De-Hui Wang, MD
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China
- Corresponding author. Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Road, Shanghai 200031, PR China. Tel.: +86 21 64 377 134 388; fax: +86 21 64 377 151.

Received 9 August 2009 published online 21 December 2009.

Abstract

Intracavernous carotid hemorrhage is a rare cause of epistaxis. We present a case of epistaxis caused by postradiotherapy and nontraumatic cavernous internal carotid artery (ICA) hemorrhage. An 80-year-old man was admitted to our hospital with a one week history of recurrent left-sided epistaxis and a past history of radiotherapy after radical maxillectomy. Emergent angiography revealed a leak in the cavernous segment of the ICA and subsequent detachable balloon occlusion embolization of the left internal carotid artery was performed without sequelae. We conclude that carotid artery hemorrhage must be considered in the differential diagnosis of profuse and recurrent epistaxis, especially for patients after craniofacial radiotherapy. ICA embolization is the definitive treatment provided cross circulation is adequate.