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Tortuous Carotid Artery in Neck
Bronwyn E. Hamilton, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Retropharyngeal carotid, carotid transposition, medialized carotid, kissing carotids
              • Definitions

                • 1 or both carotid arteries (CAs) protrude medially into retropharyngeal space (RPS)

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        • Reporting Tips

                                          Selected References

                                          1. Lukins DE et al: The moving carotid artery: a retrospective review of the retropharyngeal carotid artery and the incidence of positional changes on serial studies. AJNR Am J Neuroradiol. 37(2):336-41, 2016
                                          2. Gupta A et al: Variability in the position of the retropharyngeal internal carotid artery. Laryngoscope. 123(2):401-3, 2013
                                          3. Ekici F et al: Course anomalies of extracranial internal carotid artery and their relationship with pharyngeal wall: an evaluation with multislice CT. Surg Radiol Anat. 34(7):625-31, 2012
                                          4. Jun BC et al: Risk factors for decreased distance between internal carotid artery and pharyngeal wall. Auris Nasus Larynx. 39(6):615-9, 2012
                                          5. Marcucci C et al: Retropharyngeal carotid artery: an important anatomic variation for the anesthesiologist. Anesthesiology. 111(2):454-5, 2009
                                          6. Pfeiffer J et al: A clinical classification system for aberrant internal carotid arteries. Laryngoscope. 118(11):1931-6, 2008
                                          7. Ozgur Z et al: A study of the course of the internal carotid artery in the parapharyngeal space and its clinical importance. Eur Arch Otorhinolaryngol. 264(12):1483-9, 2007
                                          8. Ballotta E et al: Surgical vs medical treatment for isolated internal carotid artery elongation with coiling or kinking in symptomatic patients: a prospective randomized clinical study. J Vasc Surg. 42(5):838-46; discussion 846, 2005
                                          9. Coscarón Blanco E et al: [Internal carotid artery loop: an uncommon cause of parapharyngeal tumor.] An Otorrinolaringol Ibero Am. 32(2):107-13, 2005
                                          10. Even-Or E et al: Medial displacement of the internal carotid arteries in velocardiofacial syndrome. Isr Med Assoc J. 7(11):749-50, 2005
                                          11. Palacios E et al: Anomalous course of the carotid arteries in the retropharyngeal space poses a surgical risk. Ear Nose Throat J. 84(6):336-7, 2005
                                          12. Togay-Işikay C et al: Carotid artery tortuosity, kinking, coiling: stroke risk factor, marker, or curiosity? Acta Neurol Belg. 105(2):68-72, 2005
                                          13. Lai JP et al: Vascular abnormalities in the head and neck area in velocardiofacial syndrome. Chang Gung Med J. 27(8):586-93, 2004
                                          14. Galletti B et al: Internal carotid artery transposition as risk factor in pharyngeal surgery. Laryngoscope. 112(10):1845-8, 2002
                                          15. Paulsen F et al: Curving and looping of the internal carotid artery in relation to the pharynx: frequency, embryology and clinical implications. J Anat. 197 Pt 3:373-81, 2000
                                          16. Vega J et al: Internal carotid artery transposition: another cause of widening of the retropharyngeal space. Eur Radiol. 9(2):347-8, 1999
                                          17. Schumacher WA et al: [Variations in the course of the internal carotid artery: possible risks in so-called standard operations in the area of the pharynx.] Laryngorhinootologie. 77(9):517-20, 1998
                                          18. Jäckel M: [Anatomic variants of the internal carotid artery as differential parapharyngeal space-occupying lesions diagnosis.] HNO. 45(12):1018-21, 1997
                                          19. Fix TJ et al: Carotid transposition: another cause of wide retropharyngeal soft tissues. AJR Am J Roentgenol. 167(5):1305-7, 1996
                                          20. Poulias GE et al: Kinking and coiling of internal carotid artery with and without associated stenosis. Surgical considerations and long-term follow-up. Panminerva Med. 38(1):22-7, 1996
                                          21. Schenk P et al: [Current aspects in diagnosis and therapy of carotid artery kinking.] HNO. 44(4):178-85, 1996
                                          22. Deutsch MD et al: Distance between the tonsillar fossa and internal carotid artery in children. Arch Otolaryngol Head Neck Surg. 121(12):1410-2, 1995
                                          23. Tillmann B et al: [The "dangerous loop" of the internal carotid artery. An anatomic study.] HNO. 43(10):601-4, 1995
                                          24. Davis WL et al: The normal and diseased infrahyoid retropharyngeal, danger, and prevertebral spaces. Semin Ultrasound CT MR. 12(3):241-56, 1991
                                          25. Lukovskii RV et al: [Abnormal location of a large artery in the posterior wall of the pharynx.] Vestn Otorinolaringol. (4):59, 1991
                                          26. Hendrix RA et al: Localization of the carotid artery within the tonsillar fossa by Doppler flow mapping. Laryngoscope. 100(8):853-6, 1990
                                          27. MacKenzie-Stepner K et al: Abnormal carotid arteries in the velocardiofacial syndrome: a report of three cases. Plast Reconstr Surg. 80(3):347-51, 1987
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Retropharyngeal carotid, carotid transposition, medialized carotid, kissing carotids
                                                      • Definitions

                                                        • 1 or both carotid arteries (CAs) protrude medially into retropharyngeal space (RPS)

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              • Image Interpretation Pearls

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Lukins DE et al: The moving carotid artery: a retrospective review of the retropharyngeal carotid artery and the incidence of positional changes on serial studies. AJNR Am J Neuroradiol. 37(2):336-41, 2016
                                                                                  2. Gupta A et al: Variability in the position of the retropharyngeal internal carotid artery. Laryngoscope. 123(2):401-3, 2013
                                                                                  3. Ekici F et al: Course anomalies of extracranial internal carotid artery and their relationship with pharyngeal wall: an evaluation with multislice CT. Surg Radiol Anat. 34(7):625-31, 2012
                                                                                  4. Jun BC et al: Risk factors for decreased distance between internal carotid artery and pharyngeal wall. Auris Nasus Larynx. 39(6):615-9, 2012
                                                                                  5. Marcucci C et al: Retropharyngeal carotid artery: an important anatomic variation for the anesthesiologist. Anesthesiology. 111(2):454-5, 2009
                                                                                  6. Pfeiffer J et al: A clinical classification system for aberrant internal carotid arteries. Laryngoscope. 118(11):1931-6, 2008
                                                                                  7. Ozgur Z et al: A study of the course of the internal carotid artery in the parapharyngeal space and its clinical importance. Eur Arch Otorhinolaryngol. 264(12):1483-9, 2007
                                                                                  8. Ballotta E et al: Surgical vs medical treatment for isolated internal carotid artery elongation with coiling or kinking in symptomatic patients: a prospective randomized clinical study. J Vasc Surg. 42(5):838-46; discussion 846, 2005
                                                                                  9. Coscarón Blanco E et al: [Internal carotid artery loop: an uncommon cause of parapharyngeal tumor.] An Otorrinolaringol Ibero Am. 32(2):107-13, 2005
                                                                                  10. Even-Or E et al: Medial displacement of the internal carotid arteries in velocardiofacial syndrome. Isr Med Assoc J. 7(11):749-50, 2005
                                                                                  11. Palacios E et al: Anomalous course of the carotid arteries in the retropharyngeal space poses a surgical risk. Ear Nose Throat J. 84(6):336-7, 2005
                                                                                  12. Togay-Işikay C et al: Carotid artery tortuosity, kinking, coiling: stroke risk factor, marker, or curiosity? Acta Neurol Belg. 105(2):68-72, 2005
                                                                                  13. Lai JP et al: Vascular abnormalities in the head and neck area in velocardiofacial syndrome. Chang Gung Med J. 27(8):586-93, 2004
                                                                                  14. Galletti B et al: Internal carotid artery transposition as risk factor in pharyngeal surgery. Laryngoscope. 112(10):1845-8, 2002
                                                                                  15. Paulsen F et al: Curving and looping of the internal carotid artery in relation to the pharynx: frequency, embryology and clinical implications. J Anat. 197 Pt 3:373-81, 2000
                                                                                  16. Vega J et al: Internal carotid artery transposition: another cause of widening of the retropharyngeal space. Eur Radiol. 9(2):347-8, 1999
                                                                                  17. Schumacher WA et al: [Variations in the course of the internal carotid artery: possible risks in so-called standard operations in the area of the pharynx.] Laryngorhinootologie. 77(9):517-20, 1998
                                                                                  18. Jäckel M: [Anatomic variants of the internal carotid artery as differential parapharyngeal space-occupying lesions diagnosis.] HNO. 45(12):1018-21, 1997
                                                                                  19. Fix TJ et al: Carotid transposition: another cause of wide retropharyngeal soft tissues. AJR Am J Roentgenol. 167(5):1305-7, 1996
                                                                                  20. Poulias GE et al: Kinking and coiling of internal carotid artery with and without associated stenosis. Surgical considerations and long-term follow-up. Panminerva Med. 38(1):22-7, 1996
                                                                                  21. Schenk P et al: [Current aspects in diagnosis and therapy of carotid artery kinking.] HNO. 44(4):178-85, 1996
                                                                                  22. Deutsch MD et al: Distance between the tonsillar fossa and internal carotid artery in children. Arch Otolaryngol Head Neck Surg. 121(12):1410-2, 1995
                                                                                  23. Tillmann B et al: [The "dangerous loop" of the internal carotid artery. An anatomic study.] HNO. 43(10):601-4, 1995
                                                                                  24. Davis WL et al: The normal and diseased infrahyoid retropharyngeal, danger, and prevertebral spaces. Semin Ultrasound CT MR. 12(3):241-56, 1991
                                                                                  25. Lukovskii RV et al: [Abnormal location of a large artery in the posterior wall of the pharynx.] Vestn Otorinolaringol. (4):59, 1991
                                                                                  26. Hendrix RA et al: Localization of the carotid artery within the tonsillar fossa by Doppler flow mapping. Laryngoscope. 100(8):853-6, 1990
                                                                                  27. MacKenzie-Stepner K et al: Abnormal carotid arteries in the velocardiofacial syndrome: a report of three cases. Plast Reconstr Surg. 80(3):347-51, 1987