Aberrant retropharyngeal (submucosal) internal carotid artery: an under-recognized, clinically significant variant
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ANATOMIC VARIATIONS
Aberrant retropharyngeal (submucosal) internal carotid artery: an under-recognized, clinically significant variant Sivasubramanian Srinivasan • Syed Zama Ali Lim Tze Chwan
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Received: 10 August 2012 / Accepted: 23 November 2012 / Published online: 2 December 2012 Ó Springer-Verlag France 2012
Abstract We present a case of a 71-year-old woman who was incidentally found to have aberrant retropharyngeal internal carotid artery, lying very close to the pharyngeal mucosa, on imaging. Radiologists, otolaryngologists and anaesthetists should be aware of this clinically significant variant which can result in life-threatening bleeding during procedures in the oral cavity or oropharynx. Keywords
Aberrant ICA Oropharynx Bleeding
Introduction Aberrant course of internal carotid artery (ICA) is an under-recognized variant with an approximate incidence of 5 % in the neck. Very rarely it may lie in the oropharynx just beneath the mucosa. This finding may be incidentally noted during routine imaging of head and neck or patients may present with specific symptoms such as dysphagia, fullness in the throat or pulsatile swelling. This variant should be recognized before any surgical procedure in the oropharynx or insertion of tubes because of the high risk of injury to the artery, which may result in fatal bleeding.
Case report A 71-year-old woman presented with history of right sided weakness of 1 day duration. On examination there was mild decrease in the power of right upper limb (4/5). S. Srinivasan (&) S. Z. Ali L. T. Chwan Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768228, Republic of Singapore e-mail: [email protected]
No other significant abnormalities were noted. In view of the neurological symptoms of stroke she underwent ultrasonography and colour Doppler evaluation for carotid arteries which revealed calcific plaques in right ICA. Computed tomography (CT) angiogram was performed, which did not show any significant stenosis in the carotid arteries. However, the cervical segment of right ICA was tortuous and had an abnormal medial course (Fig. 1). At the level of oropharynx, the artery was just beneath the mucosa and the distance between the mucosal surface and the arterial wall was just 0.5 mm. This aberrant retropharyngeal variant was highlighted in the radiological report and the referring physician was cautioned about the course of the ICA and its implications.
Discussion Aberrant course of ICA in the pharynx is a clinically significant variant. However, the importance of this is underrecognized [7]. The incidence of aberrant ICA in the neck is said to be approximately around 5 % [3, 7]. The normal course of the cervical segment of the ICA is straight till the skull base without any branching. Variations in the course are kinking or coiling along the course or ‘S’ or ‘C’ shaped elongation with displacement [5, 6]. The medial course of the cervical segment of ICA is the one which is clinically significant because of its abnormal proximity t
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