Carotid blowout syndrome after intensity-modulated radiation therapy: A case report

Abstract

Carotid blowout syndrome (CBS) is a rarely seen complication of head-neck surgery and radiation therapy. It may present by massive ear bleeding or epistaxis with high morbidity and mortality rates. Success rate of endovascular therapy or emergency surgery is unfortunately low because of massive bleeding and weakened vessel architecture. Here, we present a 45-year-old male with nasopharyngeal carcinoma and treated with intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy. The patient was diagnosed with stage III (T3N2M0) carcinoma of the nasopharynx. Eight months after radiotherapy, he was admitted to hospital with the complaint of epistaxis. Right internal carotid angiography revealed a 4 mm pseudoaneurysm at the superior-anterior wall of the petrous and his bleeding was controlled by stenting in the same session. In this report we aimed to draw attention to this rare clinical situation that might enhance the chance of early diagnosis enabling less morbid treatment opportunities.