Unveiling diagnostic challenges and therapeutic triumphs: endovascular management of a paediatric internal carotid artery pseudoaneurysm-a case report.

Background: Internal carotid artery (ICA) pseudoaneurysms (PSAs) are exceedingly rare in the paediatric population and may arise secondary to infections, trauma, or congenital vessel wall abnormalities. Their diagnosis can be challenging due to non-specific presentations and a lack of established guidelines in children. Early recognition and appropriate intervention are critical, as complications such as rupture can be life-threatening. This case adds to the limited literature on paediatric ICA PSAs and highlights the role of endovascular treatment. Case summary: A 5-year-old boy presented with a pulsatile neck swelling persisting for 3 months, intermittent fever, and an episode of oral bleeding. Physical examination revealed a globular, pulsatile neck mass below the angle of the mandible, and imaging confirmed a right ICA PSA with a surrounding haematoma. A possible infectious or traumatic aetiology was considered. Due to the risk of rupture during intubation, a tracheostomy was performed to secure the airway. The PSA was successfully treated with endovascular coiling while preserving collateral circulation. Post-procedure recovery required intensive care monitoring due to intraoperative complications. However, the child was discharged with no neurological deficits, and at 1-month follow-up, the neck swelling had markedly reduced. Discussion: This case emphasizes the importance of considering both infectious and traumatic aetiologies in paediatric vascular lesions. It highlights the need for a multidisciplinary approach, tailored airway management, and individualized therapeutic strategies to achieve successful outcomes.