Yoğunluk ayarlı radyoterapi sonrasında gelişen carotid blowout sendromu: Olgu sunumu

Year 2017, , 124 - 129, 14.05.2017

Bilgehan Sahın Banu Atalar Abdullah Yakupoglu Enis Ozyar

https://doi.org/10.5472/marumj.344828

Abstract

Carotid blowout sendromu (CBS) veya pseudoaneurysm,

baş-boyun cerrahisi ve radyoterapi sonrası nadir görülen bir

komplikasyondur. Yüksek morbidite ve mortalite oranları ile masif

kulak kanaması veya epistaksis şeklinde görülür. Zayıflamış damar

yapısı ve masif kanama sebebiyle acil cerrahi ya da endovasküler

tedavilerin başarı şansı oldukça düşüktür. Bu yazıda, nazofarenks

kanseri tanısı olan ve eş zamanlı kemoterapi ile beraber yoğunluk

ayarlı radyoterapi (YART) C alan 3. evre (T3N2M0), 45 yaşında

erkek hasta sunulmuştur. Radyoterapi sonrası 8. ayda epistaksis

ile hastaneye başvuran hastanın sağ internal carotis arter

anjiografisinde petros segmentin antero-superior duvarında 4mm

pseudoanevrizma saptanıp aynı seansta stentle kanama kontrolu

yapılmıştır. Bu yazıda, erken tanı konulabilmesi ve dolayısıyla

daha az morbid tedavi seçeneklerinin sunulabilmesi için nadir

görülen bu klinik duruma dikkat çekilmesi amaçlanmıştır.

Keywords

YART, Carotid blowout sendromu, CBS, Pseudoanevrizma

Carotid blowout syndrome after intensity-modulated radiation therapy: A case report

Abstract

Carotid blowout syndrome (CBS) is a rarely seen complication of

head-neck surgery and radiation therapy. It may present by massive

ear bleeding or epistaxis with high morbidity and mortality rates.

Success rate of endovascular therapy or emergency surgery is

unfortunately low because of massive bleeding and weakened

vessel architecture. Here, we present a 45-year-old male with

nasopharyngeal carcinoma and treated with intensity-modulated

radiation therapy (IMRT) and concurrent chemotherapy. The

patient was diagnosed with stage III (T3N2M0) carcinoma of the

nasopharynx. Eight months after radiotherapy, he was admitted

to hospital with the complaint of epistaxis. Right internal carotid

angiography revealed a 4 mm pseudoaneurysm at the superioranterior

wall of the petrous and his bleeding was controlled by

stenting in the same session. In this report we aimed to draw

attention to this rare clinical situation that might enhance the chance

of early diagnosis enabling less morbid treatment opportunities.

Keywords

IMRT, Carotid blowout syndrome, CBS, Pseudoaneurysm

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