A RARE PRESENTATION OF DELAYED EPISTAXIS: POST TRAUMATIC INTERNAL CAROTID ARTERY PSEUDOANEURYSM AT A TERTIARY CARE CENTRE IN EASTERN NEPAL

Epistaxis is a common ENT emergency. Various causes are mucosal trauma, anticoagulants and bleeding disorders. Vascular causes and trauma accounts for less than 5% causes. A 25-year-old man presented to emergency with intractable epistaxis. He had sustained road traffic accident 5 months back. His previous CT scan showed multiple facial bones fracture along with sinuses (frontal, maxillary and sphenoid sinus on right para clinoid area) fracture. Initial CT angiography showed no vascular defects. The latest episode of epistaxis was massive and he underwent nasal endoscopy and packing of nose. Pulsatile sphenoidal polyp was visualized, along with transmitted pulsations in the sphenoid sinus on the right side. Subsequent Magnetic Resonance Angiography (MRA) showed a 12x4 mm pseudoaneurysm of clinoidal portion of Internal Carotid Artery on the right side. Post-traumatic Pseudoaneurysm of the Internal Carotid Artery may be the differential diagnosis in traumatic epistaxis, especially the delayed type. If pseudoaneurysm is suspected, CT or MRI angiography should be performed immediately.