EC Clinical and Medical Case Reports

Mycotic aneurysms of the internal carotid artery are rare but potentially life threatening vascular complications, most often related to systemic infection, septic emboli, or direct extension from adjacent infectious processes. Cervical involvement of the internal carotid artery is particularly uncommon, and cases secondary to chronic cholesteatomatous otomastoiditis remain exceptionally rare. Early diagnosis is essential because these lesions carry a high risk of rupture, thromboembolism, and neurological deterioration. We report the case of a 60 year old male presenting with acute pulsatile cervical swelling and headache in the setting of long standing untreated chronic otomastoiditis with recurrent otorrhea. Clinical examination revealed lower cranial nerve involvement and biological tests demonstrated significant inflammatory syndrome. Computed tomography of the temporal bone showed extensive mastoid destruction with erosion of the carotid canal. CT angiography of the neck demonstrated a saccular aneurysmal dilation of the cervical segment of the internal carotid artery with irregular contours and surrounding inflammatory tissue. Magnetic resonance imaging confirmed the aneurysm and identified an associated cholesteatomatous lesion with adjacent dural thickening, without evidence of cerebral ischemia or venous thrombosis. The diagnosis of mycotic aneurysm of the cervical internal carotid artery secondary to chronic cholesteatomatous automastoiditis was established based on imaging findings and clinical context. The patient was managed with broad spectrum intravenous antibiotics and referred for endovascular treatment. During the procedure, neurological deterioration occurred following guidewire placement, leading to discontinuation of the intervention. Despite supportive management, the patient experienced rapid clinical deterioration and died a few hours later. Mycotic aneurysms of the cervical internal carotid artery remain extremely rare, with most data derived from isolated case reports and small series. Chronic otomastoiditis with cholesteatoma represents an unusual but important cause through local bone erosion and direct vascular wall infection. Radiological imaging plays a central role in early detection, assessment of complications, and therapeutic planning. Multimodality imaging including CT, CT angiography, and MRI is essential to evaluate vascular involvement, inflammatory extension, and associated intracranial complications. This case highlights the importance of considering vascular complications in advanced otomastoiditis and underscores the need for rapid multidisciplinary management. Early recognition may improve outcomes and prevent catastrophic complications in this rare but potentially fatal condition.

Keywords: Mycotic Aneurysm; Internal Carotid Artery; Automastoiditis; Cholesteatoma; Osteolysis; Cervical ICA

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