Fatal Epistaxis via Carotid Aneurysm and Eustachian Tube

Abstract

EPISTAXIS is a common clinical problem and is rarely serious in its intensity. Conservative estimates indicate that about 90% of all nose bleeds occur in the capillary bed of the septum, known as Keisselbach's area. Rarely, severe epistaxis may occur from damage to the sphenopalatine artery in the posterior nares. Traumatic aneurysms of the internal carotid artery presenting with massive epistaxis are indeed rarely encountered. This report presents a case of a traumatic aneurysm of the internal carotid artery eroding into the eustachian tube, giving rise to repeated severe bleeding episodes, and ending fatally. A number of reports of aneurysms eroding into the sphenoid sinus have been made.^1-6 Only one other report of bleeding through the eustachian tube has been found in the world literature.⁷ The number of head injuries from auto accidents alone suggests that this type of injury may not be as uncommon as this report