Mycotic aneurysm of the carotid artery and contralateral carotid stenosis

Summary

Introduction

Mycotic aneurysms (MA) of the extracranial carotid artery are a very rare pathological condition. They usually appear as a pulsatile mass in the neck, associated with local inflammatory phenomena and general symptoms, which require an early diagnosis and aggressive treatment.

Case report

We report the case of a 75-year-old female patient with a long history of a feverish syndrome; the physical exploration revealed a bilateral carotid bruit and a pulsatile mass on the right side of the neck. Doppler ultrasound showed the presence of an aneurysm in the right common carotid artery (RCC) and severe stenosis of the contralateral internal carotid. The diagnosis was confirmed by means of computerised tomography (CT), magnetic resonance (MR), angiography, scintigraphy and blood cultures

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In accordance with the presumptive diagnosis of MA of the carotid artery, a one-time surgical intervention under cervical regional anaesthesia was chosen as treatment. First, a left-side carotid endarterectomy was carried out and this was followed by ligature, exclusion and drainage of the MA of the RCC. The patient progressed favourably with no neurological complications, as seen in a clinical control at four years after the intervention.

Conclusions

MA of the carotid artery must be treated surgically. We decided to carry out the correction in a single intervention, bearing in mind the surgical risk, with the support of the peroperative monitoring afforded by the cervical regional anaesthesia with the patient in a waking state. Local features did not allow the reconstruction of the continuation of the right carotid axis. This is the tenth case reported in the literature.