An unusual cause of massive hemoptysis

A 65-year-old woman presented with recurrent hemoptysis. Four years earlier she had been treated (surgery plus radiochemotherapy) for a cervical esophageal cancer with regional lymph nodes metastasis. Endoscopies showed areas of recent bleeding in the right pharynx. A 3D reconstruction from a computed tomography angiogram of the neck vessels demonstrated a right internal carotid artery (ICA) pseudo-aneurysm. Selective endovascular occlusion of the aneurysm was planned. However, the patient had a recurrence of severe hemoptysis during coiling. A selective right ICA injection showed an extravascular jet of contrast medium filling the pharynx. Occlusion of the ICA and the pseudo-aneurysm (trapping) was performed as quickly as possible successfully staunching the bleed. Selective left ICA injection confirmed occlusion of the right ICA and satisfactory cross filling through the anterior communicating artery. The woman was discharged and the hemoptysis never recurred.