Saturday 17 September 2011

Pulsatile Neck swelling due to Tortuous CCA

A 66 yo female with pulsatile neck swelling in right supraclavicular region.
This 2D TOF Non contrat MR Angiography of neck show a highly tortuous proximal most portion of right CCA  – a focal zig zag course resulting in a pulsatile neck swelling.
No obvious aneurismal dilatation.
No obvious space occupying lesion overlying CCA on cross sectional imaging.

A tortuous CCA is a benign condition, the most common differential diagnosis of a pulsatile neck swelling, usually seen on right side at the root of the neck and is otherwise asymptomatic.

In rare cases even Dysphagia has been reported with common carotid artery tortuosity - the redundant part of the artery was surgically resected and the dysphagic symptoms resolved completely. (Reference: J R Soc Med. 2005 June; 98(6): 275–276; Tortuous common carotid artery as a cause of dysphagia

Elongation and kinking of the carotid artery are usually due to atherosclerosis or fibromuscular dysplasia, but the unusual location of the proximal common carotid artery coil in these patients is most likely congenital rather than atherosclerotic.

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