AHMET BİLGEHAN ŞAHİN, Banu ATALAR, Abdullah YAKUPOGLU, Enis ÖZYAR

Yoğunluk ayarlı radyoterapi sonrasında gelişen carotid blowout sendromu: Olgu sunumu

Carotid blowout sendromu (CBS) veya pseudoaneurysm,baş-boyun cerrahisi ve radyoterapi sonrası nadir görülen birkomplikasyondur. Yüksek morbidite ve mortalite oranları ile masifkulak kanaması veya epistaksis şeklinde görülür. Zayıflamış damaryapısı ve masif kanama sebebiyle acil cerrahi ya da endovaskülertedavilerin başarı şansı oldukça düşüktür. Bu yazıda, nazofarenkskanseri tanısı olan ve eş zamanlı kemoterapi ile beraber yoğunlukayarlı radyoterapi (YART) C alan 3. evre (T3N2M0), 45 yaşındaerkek hasta sunulmuştur. Radyoterapi sonrası 8. ayda epistaksisile hastaneye başvuran hastanın sağ internal carotis arteranjiografisinde petros segmentin antero-superior duvarında 4mmpseudoanevrizma saptanıp aynı seansta stentle kanama kontroluyapılmıştır. Bu yazıda, erken tanı konulabilmesi ve dolayısıyladaha az morbid tedavi seçeneklerinin sunulabilmesi için nadirgörülen bu klinik duruma dikkat çekilmesi amaçlanmıştır.

Anahtar Kelimeler:

YART, Carotid blowout sendromu, CBS, Pseudoanevrizma

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

Carotid blowout syndrome (CBS) is a rarely seen complication ofhead-neck surgery and radiation therapy. It may present by massiveear bleeding or epistaxis with high morbidity and mortality rates.Success rate of endovascular therapy or emergency surgery isunfortunately low because of massive bleeding and weakenedvessel architecture. Here, we present a 45-year-old male withnasopharyngeal carcinoma and treated with intensity-modulatedradiation therapy (IMRT) and concurrent chemotherapy. Thepatient was diagnosed with stage III (T3N2M0) carcinoma of thenasopharynx. Eight months after radiotherapy, he was admittedto hospital with the complaint of epistaxis. Right internal carotidangiography revealed a 4 mm pseudoaneurysm at the superioranteriorwall of the petrous and his bleeding was controlled bystenting in the same session. In this report we aimed to drawattention to this rare clinical situation that might enhance the chanceof early diagnosis enabling less morbid treatment opportunities.

Keywords:

IMRT, Carotid blowout syndrome, CBS, Pseudoaneurysm,

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