Carotid blowout syndrome in patients with nasopharyngeal carcinoma: three cases

Carotid blowout syndrome (CBS) is a rare complication of radiation therapy for nasopharyngeal carcinoma (NPC), for which angiography is the gold standard for diagnosis and treatment. We report three NPC cases treated with irradiation and complicated by bleeding from the internal carotid artery. The first case presented with multiple episodes of limited nosebleeding followed by massive bleeding. Bleeding was initially stopped by internal carotid artery embolisation. A few months later, meningitis related to skull base osteoradionecrosis occurred and the patient died from sceptic shock. The second case was admitted to the hospital with severe repetitive epistaxis and despite several attempts to manage the bleeding, the patient passed away. The third case presented with a massive epistaxis that resolved itself without any treatment. Spontaneous occlusion of the internal carotid artery occurred without any neurological defects. A nasopharyngeal muscle flap was constructed to prevent meningitis. CBS is a rare but life-threatening complication that requires emergency treatment. Re-irradiation and skull base radioosteonecrosis are strong predisposing factors.