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Tortuous internal carotid artery: an important differential of the pulsatile oropharyngeal mass
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Journal Article
Tortuous internal carotid artery: an important differential of the pulsatile oropharyngeal mass
2020
Overview
On examination, a longitudinal, pulsatile lesion in the right posterolateral pharyngeal wall commenced at the junction of the oropharynx and nasopharynx, and progressed to the vallecular. Rarely, patients may present with temporary blindness, objective tinnitus,6 7 pharyngitis8 or neck mass.8 A tortuous ICA is an important differential diagnosis in suspected peritonsillar abscess and parapharyngeal neoplasm due to the necessity for fine needle aspiration or biopsy and the associated risk of major haemorrhage. Some cases report alterations in the ICA found during surgical procedures and careful adaptations which have subsequently been made during the surgery.6 In one case, an ICA was detected 1 cm to the left of the tonsils during tonsillectomy; this highlights the tangible risks to these patients.6 Further, research shows tortuosity of the ICA as a risk factor for cerebral ischaemic stroke.9 Risks of carotid tortuosity should be considered prior to neurosurgery, as detailed by Brachlow et al,10 following the death of a 30-year-old man who underwent cerebral ischaemia and brain death following rotation of the head for surgical positioning. Curving and looping of the internal carotid artery in relation to the pharynx: frequency, embryology and clinical implications.
Publisher
BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group
