A 30-year-old male who suffered aggression was referred to the emergency service of the University Hospital La Paz due to multiple incisive wounds on his face, neck, scalp and hand
Upon arrival, he was admitted to the Intensive Care Unit due to marked hypothermia, Glasgow 10, severe metabolic acidosis, hypokalemia and acute renal failure, requiring mechanical ventilation for 24 hours.
After resolution of the acute organic condition and primary suture of the wounds, the patient is transferred to the plant after 48 hours, and is discharged one week after admission.
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Six days after discharge, the patient came back to the emergency room for pain and swelling at the left preauricular level, underlying the surgical scar of one of the facial wounds.
Symptoms include tinnitus and physical examination revealed limited mouth opening and a 2 × 2 cm left preauricular tumor of soft consistency and pulsatile opening at palpation and inspection.
Auscultation of the mass reveals synchronous murmur with the arterial systolic flow.
Parotid ultrasound showed an image compatible with high flow left intraparotid arteriovenous fistula.
Cervical and cervicofacial computed tomography (CT) showed an image suggestive of a 36 × 25 × 24 cm vascular pocket located behind the left mandibular vertical branch, between the deep and superficial lobe of the parotid gland.
A probable image of the atherosclerotic process is observed from branches of the external carotid artery with venous drainage into the external jugular vein.
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With a view to a definitive diagnosis, an angiography is performed, which shows a vascular lesion and the external vein is located in the proximal portion of the internal maxillary artery and whose venous drainages are directed superiorly to the descending plexus.
It is also observed that there is retrograde flow of the facial artery towards the pocket.
The treatment is performed in the same act by embolization, through microcatheterization of the internal maxillary artery and its final occlusion is observed by retrograde filling of the facial angiography 3 × 8 mm.
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The patient was discharged with outpatient follow-up, evident clinical improvement.
CTA revealed occlusion of the internal maxillary artery with closure and thrombosis of the fistulous pocket.
Outpatient follow-up at one and six months showed no complications or recurrence.
