13 April 2020 : Case report
“Very High-Grade” Pulsatile Mass of an Aberrant Internal Carotid Artery in the Nasopharyngeal Wall: A Case Report and Review of Literature
Unusual clinical course, Mistake in diagnosis, Unusual setting of medical care, Educational Purpose (only if useful for a systematic review or synthesis)Quang Van Le1AEF*, Vy Thuc Nguyen2BCF
Am J Case Rep 2020; 21:e921967
BACKGROUND: The prevalence of aberrant internal carotid artery (ICA) is extremely low in the general population. It commonly occurs in the neck. Close proximity of the pulsatile submucosal mass of the aberrant ICA to the nasopharyngeal wall is dangerous. The complications include severe or fatal hemorrhage resulting from a missed diagnosis before intervention in this area, including tonsillectomy, adenoidectomy, eustachian tube dilation, oropharynx biopsy or resection, tracheal intubation, and neck surgery. We report the case of a 66-year-old woman who had a pulsatile mass of the kinked ICA in close proximity to the lateral nasopharyngeal wall, and provide a review of the literature.
CASE REPORT: The patient presented to our Ear, Nose, and Throat Clinic with persistent cough with phlegm. Endoscopic examination revealed an abnormal pulsatile mass in the lateral nasopharyngeal wall. Subsequent contrast-enhanced computed tomography angiography confirmed the presence of unilateral acute maxillary sinusitis, and a high-grade kinked submucosal mass of the ICA in the ipsilateral nasopharyngeal wall, concomitant with stenosis of the left ICA and left middle cerebral artery occlusion.
CONCLUSIONS: Pulsating and extremely high-grade kinking of the ICA in the lateral nasopharyngeal wall is a particularly dangerous condition. Clinicians must always consider the possibility of hemorrhage during surgery, especially in older women with arteriosclerosis. Otolaryngologists should perform comprehensive visual examinations before deciding on surgery or other medical interventions in the neck, to prevent severe or fatal hemorrhage as far as possible.
Keywords: Carotid Artery Diseases, Nasopharyngeal Neoplasms, Pathological Conditions, Anatomical, Aged, Carotid Artery, Internal, carotid stenosis, computed tomography angiography, Cough, Infarction, Middle Cerebral Artery, Nasopharynx
21 Sep 2023 : Case reportSuccessful Outpatient Treatment of Severe Diabetic-Foot Myositis and Osteomyelitis Caused by Extensively Dr...
Am J Case Rep In Press; DOI: 10.12659/AJCR.941337
21 Sep 2023 : Case reportFulminant Lymphocytic Myocarditis Successfully Managed with Intra-Aortic Balloon Pump and Extracorporeal Me...
Am J Case Rep In Press; DOI: 10.12659/AJCR.941422
21 Sep 2023 : Case reportEmphysematous Cystitis: A Rare Urologic Emergency
Am J Case Rep In Press; DOI: 10.12659/AJCR.941599
Most Viewed Current Articles
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406
07 Dec 2021 : Case reportEdwardsiella tarda: A Classic Presentation of a Rare Fatal Infection, with Possible New Background Risk Fac...
Am J Case Rep 2021; 22:e934347
13 Jul 2022 : Case reportWhistling Scrotum: An Unusual Presentation of Pneumomediastinum in the Setting of an Open Scrotal Wound
Am J Case Rep 2022; 23:e936441