Pseudoaneurysm of the Internal Carotid Artery Caused by Invasive Fungal Sinusitis Following Chemoradiotherapy for Nasopharyngeal Carcinoma

Chronic sinusitis is often caused by radiotherapy for nasopharyngeal carcinoma (NPC). In addition, reports have appeared in the literature on cases of massive bleeding from pseudoaneurysms of the internal carotid artery induced by invasive fungal sinusitis. We report on a case of rapture of a pseudoaneurysm of the internal carotid artery caused by invasive fungal sinusitis following chemoradiotherapy for NPC which was successfully treated with microcoil embolization therapy. A 69-year-old man had received concurrent chemoradiotherapy for NPC. Two years after the radiotherapy, the bleeding occurred from the superior lateral wall of the nasopharynx. Based on the enhanced neck CT scan findings, rapture of a pseudoaneurysm of the internal carotid artery was suspected. Microcoil embolization using the Seldinger method was performed on the internal carotid artery and the bleeding was stopped. The patient was then diagnosed as having invasive aspergillosis based on the pathological examination of the paranasal sinus. The fungal sinusitis was treated with Voriconazole resulting in a good outcome. In terms of the cranial symptoms after the radiotherapy for NPC, not only the recurrence of the cancer but also the possibility of fungal sinusitis and a carotid artery aneurysm should be considered.