PMC8567690_01
Right latero-cervical mass (3 cm of large axis), with inflammatory signs all around (red arrow) with cutaneous ulceration 5 cm in diameter located under the right clavicular (blue arrow) (former location of the implantable chamber).
f1000research-10-57667-g0000.jpg
PMC8567690_01_f1000research-10-57667-g0000.jpg
f1
The patient had a right latero-cervical tumefaction ( Figure 1) painful to palpation, pulsatile and expansive (3 cm-long large axis), with inflammatory signs all around. He also presented a cutaneous ulceration with a diameter of 5 cm, located under the right clavicle (former location of the implantable chamber), with inflammatory signs all around ( Figure 1).
Cervical computed tomography angiogram showing a 3 cm right common carotid artery pseudoaneurysm beginning at 2 cm of its origin and at a distance from the carotid bifurcation (red arrow), with the presence of multiple cervical lymphadenopathies.
f1000research-10-57667-g0001.jpg
PMC8567690_01_f1000research-10-57667-g0001.jpg
f2
A cervical Angio-Computed Tomography (CT) scan ( Figure 2) showed a 3 cm pseudoaneurysm of the right CCA beginning 2 cm from its origin and at a distance from the carotid bifurcation, with the presence of multiple cervical lymphadenopathies and an unimpaired cerebral circulation through the polygon of Willis.
Preoperative view, the CCA was dissected and controlled and clamped at its origin and terminated just before the carotid bifurcation (blue arrow). Mycotic aneurysm, and all-around infected tissues were resected (yellow arrow).
f1000research-10-57667-g0002.jpg
PMC8567690_01_f1000research-10-57667-g0002.jpg
f3
First, the CCA was dissected and controlled at its origin and terminated just before the carotid bifurcation ( Figure 3). An arterial clamping was made on both sides of the mycotic aneurysm, and resection of the latter, and all-around infected tissues, was performed ( Figure 3).
Preoperative view showing a cervical cutaneous fistula.
f1000research-10-57667-g0003.jpg
PMC8567690_01_f1000research-10-57667-g0003.jpg
f4
However, given the extent of the infection with brittle arterial tissue, the existence of cutaneous fistula ( Figure 4), and the excellent pulsatile arterial reflux from the CCA, the decision was made to make a simple ligation of the artery to avoid complications, especially graft rupture ( Figure 5).
Preoperative view showing ligation of the two extremities of the CCA (yellow arrow) after total debridement of the infected area (green arrow).
f1000research-10-57667-g0004.jpg
PMC8567690_01_f1000research-10-57667-g0004.jpg
f5
However, given the extent of the infection with brittle arterial tissue, the existence of cutaneous fistula ( Figure 4), and the excellent pulsatile arterial reflux from the CCA, the decision was made to make a simple ligation of the artery to avoid complications, especially graft rupture ( Figure 5).