Clinical Records

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

Y-Y Lin^a1, C-H Wang^a1, S-C Liu^a1 and H-C Chen^a1 c1

^a1 Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China

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.

(Accepted August 24 2011)

(Online publication April 19 2012)

Key words

• Carotid Artery, Internal;
• Jugular Vein;
• Tinnitus;
• Anatomy;
• Congenital Abnormalities

Correspondence:

^c1 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

Footnotes

Dr H-C Chen takes responsibility for the integrity of the content of the paper

Competing interests: None declared