Pseudoaneurysm of the Petrous Section Internal Carotid: A Co-incidence or a Complication of Chronic Otitis Media: A Case Report

Although rare, a Petrous Internal Carotid Artery (ICA) pseudoaneurysm is a possible complication following chronic otitis media. A 57-year-old woman was brought to the Emergency Department with multiple painless episodes of right ear bleeding and epistaxis over the last two months. Upon evaluation, bony dehiscence was observed over the petrous carotid’s first (proximal) genu, along with a pseudoaneurysm detected in the Magnetic Resonance Angiography (MR angiogram). The Balloon Occlusion Test (BTO) showed no cross-flow from the opposite side. Consequently, the patient was considered for high-flow bypass surgery between the external carotid artery and the M2 segment of the Middle Cerebral Artery (MCA), utilising a radial artery graft in the neurosurgery specialty. The present rare case report emphasises the significance of maintaining a high index of suspicion and implementing prompt intervention through a multidisciplinary approach. It also raises an open-ended question about whether the petrous carotid pseudoaneurysm is a complication of chronic otitis media or merely a co-incidence.