Aberrant internal carotid artery presenting as oropharyngeal mass

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A 52 years old male presented to us with complaints of throat discomfort and foreign body sensation for 2 years. The patient did

not report of any other upper aerodigestive tract symptoms. There was no history of addiction or any other comorbidities and patient

was in a good general state of health. On examination, the patient was found to have a globular pulsatile, non-tender swelling

involving left side oropharynx and tonsillar fossa region. On laryngoscopic examination, endolarynx was found to be within normal

limits. The general systemic examination was within normal limits. A contrast-enhanced CT scan was ordered and showed a markedly

tortuous internal carotid artery on the left side reaching till midline (Figure 1). The patient was reassured after explaining the

condition and advised for further follow up as needed.

The ICA normally rotates gradually and smoothly, first laterally and then posteromedially in relation to the ECA after its origin

from the carotid bifurcation and then runs a straight course to the carotid canal [1]. The normal tonsillo-carotid distance varies

with age and is usually around 25 mm in adults [2]. Pronounced anatomical aberrations involving the extracranial internal carotid

artery (ICA) have been described to be present in 5-6% of the general population [3]. The significance of such occurrence resides in

clinical symptomatology from positional central hypoperfusion or surgical risk from pharyngeal/ neck surgeries, although they are

asymptomatic in up to 80% of cases [3]. These aberrations have been classified anatomically (tortuosity, kinking or coiling) [4,5]

and clinico-radiologically (depending on the distance of ICA from the pharyngeal wall) [1]. Utmost care needs to be exercised with

careful visual and palpatory examination before undertaking diagnostic and therapeutic ventures of the pharyngeal cavity.

A 52 years old male presented to us with complaints of throat discomfort and foreign body sensation for 2 years. The patient did not report of any other upper aerodigestive tract symptoms. There was no history of addiction or any other comorbidities and patient was in a good general state of health. On examination, the patient was found to have a globular pulsatile, non-tender swelling involving left side oropharynx and tonsillar fossa region. On laryngoscopic examination, endolarynx was found to be within normal limits. The general systemic examination was within normal limits. A contrast-enhanced CT scan was ordered and showed a markedly tortuous internal carotid artery on the left side reaching till midline (Figure 1). The patient was reassured after explaining the condition and advised for further follow up as needed.

The ICA normally rotates gradually and smoothly, first laterally and then posteromedially in relation to the ECA after its origin from the carotid bifurcation and then runs a straight course to the carotid canal [1]. The normal tonsillo-carotid distance varies with age and is usually around 25 mm in adults [2]. Pronounced anatomical aberrations involving the extracranial internal carotid artery (ICA) have been described to be present in 5-6% of the general population [3]. The significance of such occurrence resides in clinical symptomatology from positional central hypoperfusion or surgical risk from pharyngeal/ neck surgeries, although they are asymptomatic in up to 80% of cases [3]. These aberrations have been classified anatomically (tortuosity, kinking or coiling) [4,5] and clinico-radiologically (depending on the distance of ICA from the pharyngeal wall) [1]. Utmost care needs to be exercised with careful visual and palpatory examination before undertaking diagnostic and therapeutic ventures of the pharyngeal cavity.

References

1. Leipzig TJ, Dohrmann GJ. The tortuous or kinked carotid artery: Pathogenesis and clinical considerations. Surg Neurol. 1986; 25: 478-86.

2. Tillmann B, Christofides C. The “dangerous loop” of the internal carotid artery. An anatomic study. HNO. 1995; 43: 601-4.

3. Pfeiffer J, Ridder GJ. A clinical classification system for aberrant internal carotid arteries. Laryngoscope. 2008; 118: 1931-6.

4. Metz H, Murray-Leslie RM, Bannister RG, Bull JW, Marshall J. Kinking of the internal carotid artery. Lancet. 1961; 1: 424-6.

5. Weibel J, Fields WS. Tortuosity, coiling, and kinking of the internal carotid artery. I. Etiology and radiographic anatomy. Neurology. 1965; 15: 7-18.

Figure 1. Contrast CT (A) Axial, (B) Coronal and (C) angiographic film showing tortuous medialized left internal carotid artery reaching till midline (red arrow).

DOI:10.4328/AEMED.147 Received: 31.10.2018 Accepted: 16.10.2018 Publihed Online: 14.01.2019 Printed Online: 01.01.2019

Corresponding Author: Anup Singh, Dept. of Otolaryngology and Head & Neck Surgery, Medanta-The Medicity, Gurugram, Haryana, India.

T.: 9811990085 E-Mail: This email address is being protected from spambots. You need JavaScript enabled to view it.m

ORCID ID: 0000-0001-9893-7106

 

Anup Singh1, Arvind Kumar Kairo2, Namrita Mehmi2

1Dept. of Otolaryngology and Head & Neck Surgery, Medanta-The Medicity, Gurugram, Haryana,

2Dept. of Otolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India

Aberrant internal carotid artery presenting as oropharyngeal mass

Oropharyngeal mass-Aberrant ICA

Additional Info

  • Recieved: 31.10.2018
  • Accepted: 16.10.2018
  • Published Online: 14.01.2019
  • Printed: 01.01.2019
  • DOI: DOI:10.4328/AEMED.147
  • Author: Anup Singh, Arvind Kumar Kairo, Namrita Mehmi
  • Identifier: DOI:10.4328/AEMED.147
  • Index Page: -
  • How to Cite: -
  • Running Title: Oropharyngeal mass-Aberrant ICA
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