Pulsatile mass in the right submandibular region reported as Aneurysm in MRI


13 month old baby was admitted with pain, right facial palsy, pulsatile mass in the right submandibular region. M R Angiogram was done in the peripheral hospital and it was reported as aneurysm from a branch of the external carotid artery. There was blood discharge from the right ear and baby was not allowing to clean it. So, it was thought that the aneurysm ruptured in to the ear. This patient was given a course of antibiotics and Spiral CT angiogram was done. It did show the communication with the aneurysm and the swelling slowly started regression with antibiotics.Pulsations in the mass disappeared. Patient was discharged with antibiotics and advised to atttend the ENT clinic for the future management of septic complications.

Dysphagia in association with Thoracoabdominal aneurysm of the Aorta

Thoracoabdominal aneuryms (TAAA)which are close to esophagus may produce extrinsic compression of esophagus. It will be seen as a smooth bulge during the
during the endoscopy. Manometric studies were found to be abnormal in these patients. In this endoscopic photograph (see the attached image) the mucosal swelling and ulceration is seen near the site of extrinsic compression. Endoscopic ultrasonography has shown gas bubbles in the wall of the esophagus. Patient was able to swallow liquids only. Such types of comression of esophagus was managed some times by medical meaures in elderly woman (>84 years) successfully. But it would need attention and intervention to releive the compression in the youger and middle aged people. We have recently managed another patient with absolute dysphagia associated with TAAA. He required Total parenteral nutrition before the Endovascular repair of the TAAA. His ability to swallow improved after the Endorepair with Endograft due to the relief of pressure over the esophagus by the TAAA.
By
Pinjala R K