Printer Friendly

Anomalous course of the carotid arteries in the retropharyngeal space poses a surgical risk.

An anomalous course of the carotid arteries in the retropharyngeal space is an unusual finding that poses a risk of vascular injury during pharyngeal surgery. The risk is conferred by the close proximity of these arteries to the midline of the posterior portion of the pharynx. Two cases illustrate such a finding:

* Patient 1 was a 79-year-old man who had been diagnosed with left tonsillar squamous cell carcinoma. On endoscopic examination, we noted a significant distortion of the posterior pharyngeal wall, which warranted a biopsy. Computed tomography (CT) with contrast obtained prior to the biopsy demonstrated anomalous bilateral retropharyngeal internal carotid arteries and arteriosclerotic changes. These changes had caused retropharyngeal alterations, more pronounced on the left, adjacent to the tumor (figure 1).

[FIGURE 1 OMITTED]

* In patient 2, a 26-year-old woman, we identified an anomalous course of the carotid arteries in the retropharyngeal area. The clinically silent anomaly was identified on CT as an incidental finding (figure 2).

[FIGURE 2 OMITTED]

Embryologically, the carotid arteries originate in the third aortic arch and the dorsal aorta. Normally, the dorsal aortic root has descended into the chest by the eighth week of development, thereby straightening the course of the internal carotid artery. (1) However, it has been postulated that incomplete straightening of the carotid vessels enables the embryonic angulation to persist, resulting in congenitally tortuous or aberrant internal carotid arteries in the retropharyngeal space. Anatomic descriptions of tortuous internal carotid arteries in the otolaryngology literature range from mild kinking to the formation of complete circular loops. (1,2) Congenitally tortuous courses may become more pronounced in the elderly secondary to atherosclerosis and/or hypertension, as occurred in the first case noted here. (1) In such cases, widening of the pre-vertebral retropharyngeal soft tissues can also occur; this widening can be demonstrated on conventional imaging of the cervical spine. (2) However, CT, digital angiography (figure 3), and magnetic resonance angiography may clearly demonstrate the aberrant position and course of the carotid arteries to better advantage. (4,5)

[FIGURE 3 OMITTED]

References

(1.) Shanley DJ. Bilateral aberrant cervical internal carotid arteries. Neuroradiology 1992;35:55-6.

(2.) Fix TJ, Daffner RH, Deeb ZL. Carotid transposition: Another cause of wide retropharyngeal soft tissues. AJR Am J Roentgenol 1996; 167:1305-7.

(3.) Walsh DW, Ho VB, Borke RC, Rovira MJ. Anomalous course of the common carotid arteries: CT and MRA illustration--A case report. Angiology 1998;49:235-8.

(4.) Collazo-Ornes P, Figueroa RE, Escobar W. Anatomia y patologia de la region infrahioidea. In: Rodriguez-Carbajal J, Palacios E, Figueroa RE, eds. Neurorradiologia: Cabeza y Cuello. Philadelphia: Lippincott Williams & Wilkins, 1999:555-71.

(5.) Shankar L, Mehta A L, Hawke M, Rutka J. High-resolution computed tomography of an aberrant internal carotid artery. J Otolaryngol 1992;21:373-5.

From the Department of Radiology (Dr. Palacios and Dr. Rojas) and the Department of Otolaryngology (Dr. Kirsh), Louisiana State University Health Sciences Center, New Orleans.
COPYRIGHT 2005 Vendome Group LLC
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2005, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:IMAGING CLINIC
Author:Rojas, Rafael
Publication:Ear, Nose and Throat Journal
Geographic Code:1USA
Date:Jun 1, 2005
Words:481
Previous Article:Acute vocal fold hemorrhage.
Next Article:Vestibular findings in a young man with dizziness and headaches.
Topics:


Related Articles
Carotid surgery comes with complications.
Why don't racing horses fry their brains?
Carotid surgery stands test of time.
Lateralized carotid artery: An unusual cause of pulsatile tinnitus.
A new case of a branchial cyst of the parapharyngeal space.
Target-specific multimodality endovascular management of carotid artery blow-out syndrome. (Original Article).
Anomalous course of the cervical carotid arteries. (Imaging Clinic).
Aberrant internal carotid artery as a cause of pulsatile tinnitus and an intratympanic mass. (Imaging Clinic).
Impacted pharyngeal fish bone migrating to the retropharynx.

Terms of use | Privacy policy | Copyright © 2020 Farlex, Inc. | Feedback | For webmasters