Aberrant internal carotid artery presenting as a retrotympanic                     vascular mass

We report a case of a young woman with an aberrant right internal carotid artery (ICA) presenting as a retrotympanic reddish mass. This variant of the ICA represents the collateral pathway that is formed as a result of an embryological agenesis of the cervical segment of the ICA. The embryonic inferior tympanic artery is recruited to bypass the absent carotid segment. This hypertrophied vessel may be seen otoscopically and wrongfully considered to be a vascular middle ear tumor. Informing the otorhinolaryngologist of this important vascular variant not only obviates biopsy but also helps in careful preoperative planning of eventual middle ear procedures.

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An aberrant internal carotid artery in the temporal bone presenting as a middle-ear mass: a case report

The Journal of Laryngology & Otology ◽

10.1017/s0022215107000199 ◽

2007 ◽

Vol 122 (9) ◽

pp. 983-985 ◽

Cited By ~ 10

Author(s):

A Eryilmaz ◽

M Dagli ◽

M Cayonu ◽

E Dursun ◽

C Gocer

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Temporal Bone ◽

Middle Ear ◽

Internal Carotid ◽

Middle Ear Surgery ◽

Computed Tomography Scan ◽

Ear Surgery ◽

Aberrant Internal Carotid Artery ◽

Tomography Scan

AbstractObjective:To draw attention to the possibility of an aberrant internal carotid artery behind an intact tympanic membrane presenting as a middle-ear mass.Case:A 48-year-old female patient presented with a hearing impairment in her right ear that had started 10 years ago. Otoscopic examination revealed a retro-tympanic mass. A high resolution computed tomography scan of the temporal bone was performed that showed protrusion of the internal carotid artery into the middle ear. Magnetic resonance angiography provided excellent visualisation of the internal carotid artery. Finally, a diagnosis of an aberrant internal carotid artery was made and the patient was evaluated with a conservative approach.Conclusion:All retro-tympanic masses should ideally be visualised with a computed tomography scan of the temporal bone before any middle-ear surgery, such as tympanotomy and biopsy, and it is essential for every otologist who undertakes myringotomy and middle-ear surgery to know about this rare entity.

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Aberrant internal carotid artery lying within the middle ear

Neuroradiology ◽

10.1007/bf00339565 ◽

1985 ◽

Vol 27 (4) ◽

pp. 322-326 ◽

Cited By ~ 18

Author(s):

J. D. Swartz ◽

Margaret L. Bazarnic ◽

T. P. Naidich ◽

L. D. Lowry ◽

H. T. Doan

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Aberrant Internal Carotid Artery

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Aberrant Internal Carotid Artery in the Middle Ear

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948109000117 ◽

1981 ◽

Vol 90 (1) ◽

pp. 67-69 ◽

Cited By ~ 24

Author(s):

Roy S. Goodman ◽

Noel L. Cohen

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Stapedial Artery ◽

Rare Anomaly ◽

Bony Canal ◽

Aberrant Internal Carotid Artery ◽

Ear Symptoms

Aberrant internal carotid artery in the middle ear is a rare anomaly. Myringotomy in a patient with this anomaly caused violent hemorrhage, requiring immediate packing and eventual ligation of the artery. The anomaly may represent the artery bulging through a dehiscent bony canal, or it may be due to traction on the developing carotid by a persistent stapedial artery. Various middle ear symptoms have been reported in earlier cases. Diagnosis is by angiography, and therapy is surgical.

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Otorrhagia from the “Aberrant Internal Carotid” Artery in the Middle Ear

Interventional Neuroradiology ◽

10.1177/159101999700300305 ◽

1997 ◽

Vol 3 (3) ◽

pp. 231-238 ◽

Cited By ~ 3

Author(s):

M. Söderman ◽

M. Moersdorf ◽

M. Lysdahl ◽

L. Mendel

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Large Artery ◽

Arterial Aneurysm ◽

Anatomical Variant ◽

Cervical Portion ◽

Aberrant Internal Carotid Artery ◽

The Brain

Agenesis of the cervical portion of the internal carotid artery (ICA) may result in blood supply to the ipsilateral cerebral hemisphere being provided by an enlarged inferior tympanic branch of the ascending pharyngeal artery. This enlarged vessel, passing through Jacobson's canal and anastomosing with the likewise enlarged caroticotympanic branch of the ICA in front of the promontorium, may simulate a middle ear mass. We present five patients with this unusual anatomical variant, three of which underwent biopsy of what was believed to be a middle ear tumour. One patient experienced rupture of an arterial aneurysm in the middle ear successfully treated with endovascular application of detachable platinum coils. It is mandatory for ENT-surgeons and radiologists who perform head-and-neck examinations to recognize this anatomical variant, not mistaking it for a tumour, since biopsy of a large artery supplying the brain may have disastrous consequences. In patients with otorrhagia, an arterial aneurysm must be considered as a possible source of bleeding, in some cases amenable for treatment with an endovascular technique. The diagnosis of “aberrant internal carotid artery” is usually made with CT of the temporal bone or MR of the skull base. Cerebral angiography is in most cases not necessary, unless an endovascular procedure is planned.

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Aberrant Internal Carotid Artery in the Middle Ear

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940111000915 ◽

2001 ◽

Vol 110 (9) ◽

pp. 892-894 ◽

Cited By ~ 9

Author(s):

Gerd Jürgen Ridder ◽

Milo Fradis ◽

Jörg Schipper

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Aberrant Internal Carotid Artery

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Summary Aberrant Internal Carotid Artery in the Middle Ear

JOURNAL OF JAPAN SOCIETY FOR HEAD AND NECK SURGERY ◽

10.5106/jjshns.14.315 ◽

2004 ◽

Vol 14 (3) ◽

pp. 315-318

Author(s):

Yasuo Mishiro ◽

Tadashi Kitahara ◽

Yoshifumi Yamamoto ◽

Takeshi Kubo

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Aberrant Internal Carotid Artery

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Surgical treatment for the aberrant internal carotid artery in the middle ear with pulsatile tinnitus

Auris Nasus Larynx ◽

10.1016/j.anl.2013.10.002 ◽

2014 ◽

Vol 41 (2) ◽

pp. 215-218 ◽

Cited By ~ 9

Author(s):

Yohei Honkura ◽

Hiroshi Hidaka ◽

Jun Ohta ◽

Shigeki Gorai ◽

Yukio Katori ◽

...

Keyword(s):

Surgical Treatment ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Pulsatile Tinnitus ◽

Aberrant Internal Carotid Artery

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Aberrant Internal Carotid Artery in the Middle Ear

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894041130s301 ◽

2004 ◽

Vol 113 (3_suppl) ◽

pp. 1-16 ◽

Cited By ~ 13

Author(s):

Jochen P. Windfuhr

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Aberrant Internal Carotid Artery

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A Potentially Catastrophic Anatomical Variation: Aberrant Internal Carotid Artery in the Middle Ear Cavity

Case Reports in Otolaryngology ◽

10.1155/2013/743021 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Togay Muderris ◽

Sami Bercin ◽

Ergun Sevil ◽

Huseyin Cetin ◽

Muzaffer Kiris

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Temporal Bone ◽

Middle Ear ◽

Internal Carotid ◽

Anatomical Variation ◽

Vascular Anomaly ◽

Massive Hemorrhage ◽

Tympanic Membrane Perforation ◽

Aberrant Internal Carotid Artery

Aberrant internal carotid artery (ICA) is a rare but a very important vascular anomaly of temporal bone. Misdiagnosis of the anomaly may lead to massive hemorrhage and severe complications during otologic procedures. It is essential to keep this anomaly in mind for any otologic surgeon to prevent catastrophic complications. We present a case of aberrant ICA appeared as a nonpulsatile middle ear mass. The patient had a complaint of hearing loss, and the otoscopic examination of the patient revealed a tympanic membrane perforation and a blue-reddish retrotympanic mass. Multidetector computed tomography (MDCT) is a useful tool that may provide excellent visualization of temporal bone for the diagnosis of aberrant ICA. Otolaryngologists should be aware of the possibility of a vascular anomaly of temporal bone when a patient presents with a blue-reddish mass in the middle ear.

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