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Background <p>Pseudoaneurysms following radiotherapy for nasopharyngeal carcinoma (NPC) commonly involve the internal carotid artery (ICA) with epistaxis. External carotid artery (ECA) pseudoaneurysm complicated by temporal bone osteoradionecrosis (ORN) presenting with otorrhagia represents an exceptionally rare, life-threatening complication.</p> Methods <p>We reported a case of delayed otorrhagia due to superficial temporal artery pseudoaneurysm complicated by temporal bone ORN and conducted a literature review of radiation-induced carotid pseudoaneurysms in NPC patients. A PubMed search (2004–2025) was conducted with key words “nasopharyngeal carcinoma”, “pseudoaneurysm”, “carotid artery” and “radiotherapy” to identify similar cases.</p> Results <p>We identified 16 cases of radiation-induced carotid artery pseudoaneurysms in NPC patients, with eight cases demonstrating skull base ORN and two originating from ECA, none showing tumor recurrence. Our case was managed through CT angiogram followed by selective ECA digital subtraction angiography with successful coil embolization.</p> Conclusion <p>This first-reported case of ECA branch pseudoaneurysm secondary to temporal bone ORN establishes that ORN and soft tissue necrosis predispose to pseudoaneurysm formation. The 19-year latency period highlights the necessity for long-term surveillance in high-risk patients. First-line CT angiography should mandate comprehensive ECA evaluation. Sentinel bleeding episodes with soft tissue necrosis warrant vascular assessment to mitigate pseudoaneurysm rupture risk.</p>

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Delayed otorrhagia due to Radiation-induced external carotid artery pseudoaneurysm complicated by Temporal bone osteoradionecrosis in nasopharyngeal carcinoma: A case report and literature review

  • 期刊论文

  • 发表日期：

    2025年8月20日

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  • Phoebe Hiu Wai Lo,
  • Hoi Ming Kwok,
  • Lik Fai Cheng,
  • Ka Fai Johnny Ma

摘要

Background

Pseudoaneurysms following radiotherapy for nasopharyngeal carcinoma (NPC) commonly involve the internal carotid artery (ICA) with epistaxis. External carotid artery (ECA) pseudoaneurysm complicated by temporal bone osteoradionecrosis (ORN) presenting with otorrhagia represents an exceptionally rare, life-threatening complication.

Methods

We reported a case of delayed otorrhagia due to superficial temporal artery pseudoaneurysm complicated by temporal bone ORN and conducted a literature review of radiation-induced carotid pseudoaneurysms in NPC patients. A PubMed search (2004–2025) was conducted with key words “nasopharyngeal carcinoma”, “pseudoaneurysm”, “carotid artery” and “radiotherapy” to identify similar cases.

Results

We identified 16 cases of radiation-induced carotid artery pseudoaneurysms in NPC patients, with eight cases demonstrating skull base ORN and two originating from ECA, none showing tumor recurrence. Our case was managed through CT angiogram followed by selective ECA digital subtraction angiography with successful coil embolization.

Conclusion

This first-reported case of ECA branch pseudoaneurysm secondary to temporal bone ORN establishes that ORN and soft tissue necrosis predispose to pseudoaneurysm formation. The 19-year latency period highlights the necessity for long-term surveillance in high-risk patients. First-line CT angiography should mandate comprehensive ECA evaluation. Sentinel bleeding episodes with soft tissue necrosis warrant vascular assessment to mitigate pseudoaneurysm rupture risk.