Radiotherapy-induced Acute Carotid Blowout Syndrome in Base of Tongue Cancer

Abstract

Carotid blowout syndrome is an uncommon and fatal medical emergency in patients with head and neck cancer. Tumor progression, previous surgery, and radiotherapy on the head and the neck regions are some of the predisposing factors that affect its presentation. An early suspicion of a carotid blowout syndrome allows early safety measurements to prevent catastrophic events. A 71-year-old man with advanced base of tongue cancer was presented with a self- limiting oral bleeding 18 months after receiving chemoradiotherapy. Fiberoptic laryngoscopy and contrast-enhanced computed tomography revealed the presence of edema of the hypopharynx and thyroid cartilage fracture and necrosis. The patient developed acute oral hemorrhage. Surgical intervention was insufficient to achieve hemostasis. The carotid angiography revealed a common carotid artery rupture, and a covered stent was placed endovascularly. The covered stent placement was enough to stop the bleeding. However, the patient died from perioperative complications. Experience is necessary for the early detection and prevention of a carotid blowout syndrome.