Ruptured Mycotic Internal Carotid Artery Pseudoaneurysm Presenting as Massive Hematemesis in a Child

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Ruptured mycotic right internal carotid artery pseudoaneurysm with parapharyngeal abscess presenting as massive hematemesis (n=1). Intervention: Covered-stent reconstruction (6 x 37 mm Lifestream covered stent), dual antiplatelet therapy (aspirin and clopidogrel), surgical drainage of abscess, and broad-spectrum intravenous antibiotics (ceftriaxone, vancomycin, and metronidazole). Primary outcome: Exclusion of the pseudoaneurysm, cessation of bleeding, and long-term vessel patency without recurrence.

Mohanned Mhairat; Mu’taz I. Alfreahat; Amjed Adnan Tarifi; Farid Aladham; Fatehi M. Malaysheh; Lana Alzayadneh

doi:10.1002/ccr3.73897

November 1, 2026Clinical Case ReportsOpen Access

Ruptured Mycotic Internal Carotid Artery Pseudoaneurysm Presenting as Massive Hematemesis in a Child

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Key result

Covered-stent placement with drainage successfully excludes carotid mycotic pseudoaneurysms, maintaining patency through ~12 months.

n=1

Why the study?

Massive hematemesis in children rarely originates from vascular etiologies such as a mycotic internal carotid artery pseudoaneurysm, requiring early suspicion and multidisciplinary management.

Key Points

To describe the diagnosis and multidisciplinary management of massive hematemesis secondary to a ruptured mycotic internal carotid artery pseudoaneurysm in a pediatric patient.
Evaluated a child presenting with massive hematemesis and unilateral neck swelling using upper endoscopy and contrast-enhanced computed tomography.
Deployed a 6 × 37 mm Lifestream covered stent across the right internal carotid artery pseudoaneurysm with systemic heparinization, followed by surgical drainage and packing of an adjacent parapharyngeal abscess.
Administered broad-spectrum intravenous antibiotics (ceftriaxone, vancomycin, and metronidazole) alongside dual antiplatelet therapy with aspirin and clopidogrel, monitoring outcomes through 12 months.
Stent deployment achieved complete angiographic exclusion of the 1 cm saccular pseudoaneurysm with preserved arterial flow, resulting in cessation of bleeding and hemoglobin stabilization from 6.6 g/dL up to 12.9 g/dL by Day six.
Follow-up magnetic resonance imaging at 6 weeks demonstrated near-complete resolution of the 4.2 × 1.8 cm parapharyngeal abscess and thrombosis of the pseudoaneurysm.
At 12-month follow-up, the patient remained asymptomatic without recurrent hematemesis, neck swelling, neurological deficits, or evidence of recurrent infection.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 previously healthy 5-year-old boy with a ruptured mycotic right internal carotid artery pseudoaneurysm and parapharyngeal abscess presenting with massive hematemesis, followed for 12 months.

I

Intervention

Endovascular covered-stent reconstruction using a 6 x 37 mm covered stent via right common femoral arterial access under general anesthesia with intraoperative IV heparin (ACT ~200 s), combined with surgical drainage and packing of the parapharyngeal abscess, a 6-week course of broad-spectrum IV antibiotics (ceftriaxone, vancomycin, and metronidazole), and dual antiplatelet therapy (loaded with aspirin and clopidogrel prior to procedure, continued on aspirin 100 mg oral once daily and clopidogrel 75 mg oral once daily for 1 week, then clopidogrel reduced to 37.5 mg once daily, planned for 18 months).

O

Outcome

Complete exclusion of the pseudoaneurysm with preserved right internal carotid artery flow, cessation of bleeding, resolution of abscess, and absence of recurrent hematemesis, neurological deficits, or infection recurrence at 12-month follow-up.hard clinical

This case demonstrates that ruptured mycotic internal carotid artery pseudoaneurysm can present as massive hematemesis in children and can be safely and effectively managed with endovascular covered-stent reconstruction alongside antimicrobial therapy and abscess drainage.

Limitations

No specimen from the parapharyngeal collection was sent for microbiological culture or histopathological examination, so microbiological confirmation of the infectious etiology was unavailable
Congenital or connective tissue causes were not formally excluded
The exact anatomical route by which bleeding entered the pharynx could not be established
No specimen from the parapharyngeal collection was sent for microbiological culture or histopathological examination, precluding microbiological confirmation of the infectious etiology
Blood cultures remained sterile
Congenital or connective tissue abnormalities were not formally excluded
The exact route by which bleeding entered the pharynx could not be established

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Implication

Supports evaluation for vascular sources in unexplained pediatric hematemesis; leaves open the need for prospective data on stenting durability.

Abstract

Massive hematemesis in children may rarely originate from vascular etiologies such as mycotic internal carotid artery pseudoaneurysm. Early suspicion and multidisciplinary management are crucial. Our case highlights the importance of considering vascular etiologies in unexplained bleeding and demonstrates that endovascular stenting can provide effective, life‐saving treatment.

Discussion

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Cite This Study

Mhairat et al. (2026) conducted a case report in Ruptured mycotic right internal carotid artery pseudoaneurysm with parapharyngeal abscess presenting as massive hematemesis (n=1). Covered-stent reconstruction (6 x 37 mm Lifestream covered stent), dual antiplatelet therapy (aspirin and clopidogrel), surgical drainage of abscess, and broad-spectrum intravenous antibiotics (ceftriaxone, vancomycin, and metronidazole) was evaluated on Exclusion of the pseudoaneurysm, cessation of bleeding, and long-term vessel patency without recurrence. Endovascular covered-stent placement combined with abscess drainage and antibiotics excluded the mycotic internal carotid artery pseudoaneurysm, remaining patent and symptom-free at 12 months.

synapsesocial.com/papers/6af5cd26a40bbe8669e89bb0 https://doi.org/10.1002/ccr3.73897

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Ruptured Mycotic Internal Carotid Artery Pseudoaneurysm Presenting as Massive Hematemesis in a Child

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Ruptured Mycotic Internal Carotid Artery Pseudoaneurysm Presenting as Massive Hematemesis in a Child

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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