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Radiology quiz case 2. Postirradiation pseudoaneurysm of the petrous segment of the ICA.

A 54-YEAR-OLD WOMAN PRESENTED WITH copious right-sided epistaxis of 5 hours’ duration. She had sought prior treatment for recurrent unilateral epistaxis multiple times over a 3-month period and had undergone right sphenopalatine artery ligation. Her medical history was notable for nasopharyngeal carcinoma with radiation therapy 11 years earlier. Magnetic resonance imaging did not demonstrate tumor recurrence. Anterior nasal packing was placed, and the patient was admitted for in-house observation. On hospital day 2, she developed massive right-sided nasal bleeding that was refractory to the placement of bilateral anterior and posterior nasal packing. She was then taken emergently to the neuroangiography suite for further evaluation. Images from the lateral transnasal and anterposterior intracranial angiograms of the right internal carotid artery (ICA) are shown in Figure 1 and Figure 2. What is your diagnosis?