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Clinical Problem Solving: Radiology
March 2013

Radiology Quiz Case 1: Diagnosis

Author Affiliations


JAMA Otolaryngol Head Neck Surg. 2013;139(3):308. doi:10.1001/archotol.139.3.308

Extracranial mycotic aneurysms of the carotid artery are rare. There have been only 8 reports of mycotic carotid aneurysms owing to Salmonella septicemia since 1966.1,2 The typical presentation of mycotic aneurysm is an enlarging, pulsatile neck mass associated with pain, tenderness, and fever.3 Other clinical manifestations include recurrent hemorrhages from the oropharynx, ear, or nose; unexpected anemia; a purplish-brown discoloration of the skin or oral mucosa; cervical bruit or thrill; lower cranial nerve palsies; Horner syndrome; swelling of the parotid gland; trismus; medial bulging of the pharyngeal wall; persistent fever; and lethargy.4 Nevertheless, extracranial mycotic aneurysms can lead to severe morbidity and mortality if diagnosis is delayed or if left untreated.5

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