947 Mycotic Pseudoaneurysm Of the Common Carotid Artery: A Rare Neck Lump

Mycotic pseudoaneurysms are rare, potentially fatal arterial wall infections of either fungal or bacterial origin. The estimated incidence is 20 cases/decade. Trauma is the commonest cause and in 25% the cause remains unknown. A 62-year-old man presented with a three-week history of a non-tender enlarging neck lump associated with hoarseness of voice. He was apyrexial with no stridor nor dysphagia. The lump measured 10x10cm at levels II-III on the left side of the neck with no overlying erythema. After normal oral examination, flexible nasendoscopy revealed a left-sided pharyngeal swelling occluding 25% of the airway. He was commenced on intravenous antibiotics and steroids. A contrast enhanced CT demonstrated a mycotic pseudoaneurysm of the left common carotid artery (CCA) with a linear foreign body exiting the oesophagus. He underwent emergency surgery with the vascular team to excise 3cm of unhealthy CCA with long saphenous vein graft repair. Neck exploration and panendoscopy found no further defects including no foreign body. He made an excellent recovery and is awaiting an injection thyroplasty to manage his complete left vocal cord palsy. Although rare, vascular injury and subsequent pseudoaneurysm is an important differential and should always be considered in those presenting with neck swelling.