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|Year : 2017 | Volume
| Issue : 2 | Page : 431-432
Bilateral retropharyngeal internal carotid artery: A rare and potentially fatal anatomic variation
Mahesh Prakash, S Abhinaya, Ajay Kumar, Niranjan Khandelwal
Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||10-Mar-2017|
Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Prakash M, Abhinaya S, Kumar A, Khandelwal N. Bilateral retropharyngeal internal carotid artery: A rare and potentially fatal anatomic variation. Neurol India 2017;65:431-2
|How to cite this URL:|
Prakash M, Abhinaya S, Kumar A, Khandelwal N. Bilateral retropharyngeal internal carotid artery: A rare and potentially fatal anatomic variation. Neurol India [serial online] 2017 [cited 2017 Nov 20];65:431-2. Available from: http://www.neurologyindia.com/text.asp?2017/65/2/431/201827
A 45-year-old female patient came to our department for contrast-enhanced computed tomography (CT) for staging of non- Hodgkin lymphoma. The CT scan detected enlarged lymph nodes in the neck. Apart from lymph nodes, we observed enhancing structures in the retropharyngeal location [Figure 1]. We further traced them and made angiographic images to confirm this important anatomical variation of retropharyngeal course of bilateral internal carotid artery (ICA) [Figure 2].
|Figure 1: Volume-rendered computed tomography angiographic image of the aortic arch and its branch vessels; the carotid arteries and cervical segments of both ICA showing extreme medial curve (arrows)|
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|Figure 2: Contrast-enhanced computed tomography axial image of the neck at oropharyngeal level showing retropharyngeal location of both ICAs causing a contour bulge in the posterior wall of the pharynx (arrows)|
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The retropharyngeal space is a midline deep neck space that extends from the base of the skull to D3-D4 vertebral level, being bounded by the buccopharyngeal fascia anteriorly and alar layer of the deep cervical fascia posteriorly. It is divided by a midline raphe into two compartments, its only contents being retropharyngeal lymph nodes and adipose tissue. Pathology that may be present in this space includes lymphadenopathy, abscesses, hematomas, benign and malignant neoplasms, and rarely, ICA when its medially deviated.
The ICA is divided into cervical, petrous, cavernous, and cerebral segments. Of these, the cervical segment originates from the common carotid artery at the carotid bifurcation at C3-C4 level. The cervical segment is normally straight and non-branching; however, anatomic variations in the cervical ICA are a common occurrence and they may be of three types, namely, tortuosity, kinking, and coiling. Of these, the medial deviation or tortuosity can be of variable degree, most extreme being its retropharyngeal transposition. This is a rare occurrence with only a few case reports in history. Most commonly, this finding is incidental.
Few explanations for the medial tortuosity and looping with resultant retropharyngeal translocation of the ICA include a congenital etiology, arteriosclerosis of the vessel, vasculitis, age related changes (loss of elasticity), and fibromuscular dysplasia. The significance of this variation lies in the correct identification of the vascular etiology. Thus, an overzalous intervention to deal with the retropharyngeal mass is avoided.
Importance of this variation with regard to the patient's symptomatology is the possibility of development of symptoms such as foreign body sensation, feeling of a pulsatile mass in the throat, and hoarseness of voice; and, in the preoperative planning of procedures in the oropharyngeal region such as a tonsillectomy and an adenoidectomy. This condition should be kept in mind as a rare differential diagnosis of a retropharyngeal mass before considering a biopsy. An association of this finding with velofaciocardial syndrome has also been described.
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[Figure 1], [Figure 2]