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Aberrant internal carotid artery in the middle ear with dehiscent high jugular bulb

Published online by Cambridge University Press:  19 April 2012

Y-Y Lin ,
C-H Wang ,
S-C Liu  and
H-C Chen
Y-Y Lin
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
C-H Wang
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
S-C Liu
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
H-C Chen*
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
*
Address for correspondence: Dr Hsin-Chien Chen, Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Sec 2, Cheng-Kung Rd, Taipei 114, Taiwan, ROC Fax: 886 2 87927193 E-mail: acolufreia@yahoo.com.tw
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Abstract

Objective:

We report an extremely rare case of an aberrant internal carotid artery in the middle ear, together with a dehiscent high jugular bulb, a combination never previously reported.

Methods:

Case report with a review of the literature.

Results:

A 24-year-old man presented with a five-year history of aural fullness, pulsatile tinnitus and mild hearing impairment in his right ear. Otoscopy revealed a retro-tympanic mass. Computed tomography of the temporal bone revealed protrusion of the right internal carotid artery into the middle-ear cavity, with a dehiscent high jugular bulb. Magnetic resonance angiography showed a reduced diameter and lateralisation of the right internal carotid artery. A diagnosis of an aberrant internal carotid artery with a dehiscent high jugular bulb was made, and the patient was managed with conservative treatment.

Conclusion:

The otologist should be aware of the possibility of an aberrant internal carotid artery when the patient presents with a retro-tympanic mass, hearing loss and pulsatile tinnitus. Radiological investigation is required to make the differential diagnosis. When an aberrant internal carotid artery presents with a dehiscent high jugular bulb, the risk of serious bleeding is elevated. We recommend a conservative approach for cases presenting without bleeding complications.

Keywords

Carotid Artery, InternalJugular VeinTinnitusAnatomyCongenital Abnormalities
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 6 , June 2012 , pp. 645 - 647
Copyright
Copyright © JLO (1984) Limited 2012

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