Mycotic aneurysm of the carotid bifurcation in the neck: Case report and review of the literature

OBJECTIVE AND IMPORTANCE: Mycotic aneurysms of the extracranial carotid art ery are rare and difficult to diagnose. A search of the world literature pu blished since 1966 reveals at least six cases of mycotic carotid aneurysms due to a Salmonella septicemia. We present an exceptional case of mycotic p seudoaneurysm of the bifurcation of the carotid artery due to Salmonella se pticemia and discuss the pathogenesis as well as various aspects of the dia gnosis and surgical management. CLINICAL PRESENTATION: A 68-year-old man presented in Poland with Salmonell a sepsis; 1 month later, he was admitted to the emergency department of the Sir Mortimer B, Davis-Jewish General Hospital in Montreal with a bulky and pulsatile right cervical mass. An angiogram and a computed tomographic sca n revealed a voluminous and partially thrombosed aneurysm the size of a tan gerine originating from the posterior aspect of the carotid junction. INTERVENTION: Balloon trapping was attempted at the Montreal Neurological H ospital. Subsequently, the patient developed a significant neurological def icit, which was quickly reversed by the administration of hypertensive, hyp ervolemic, and hemodilution therapy. Thereafter, the pseudoaneurysm was res ected surgically, and the internal and external carotid arteries were sacri ficed. Pathological examination of the excised specimen of the carotid junc tion revealed a pseudoaneurysm. Bacterial culture of the lesion showed grow th of Salmonella. CONCLUSION: The postoperative course was satisfactory except for laryngeal paralysis due to involvement of the vagus nerve. Four months later, a compu ted tomographic scan showed only small lacunae in both centra semiovale.