Key result
Neck CT identifies retropharyngeal internal carotid artery kinking causing pulsatile tinnitus, managed conservatively without intervention.
Why the study?
An aberrant cervical internal carotid artery rarely presents as a pulsatile submucosal mass in the posterior pharyngeal wall, and most affected patients have been documented as case reports.
Case Report (n=1)
Clinicians should consider an aberrant internal carotid artery in elderly patients presenting with a pulsatile pharyngeal mass or tinnitus, and document the anomaly to prevent fatal hemorrhage during intubation or neck surgery.
Answers are grounded in this paper and cite their sources.
Alerts clinicians to vascular anomalies before pharyngeal interventions; leaves open optimal screening protocols for pulsatile tinnitus.
Background: An aberrant cervical internal carotid artery rarely presents as a pulsatile submucosal mass closely related to the posterior pharyngeal wall. It can be completely asymptomatic or may sometimes manifest with tinnitus, dizziness, dysphagia, or sleep disorders. Most such patients have been documented in the literature as case reports. Case report: Here, we present the case of a 69-year-old man with a complaint of right-sided pulsatile tinnitus for more than 2 years. An ENT examination revealed submucosal pulsatile swelling on the right side of the posterior pharyngeal wall. A contrast-enhanced CT of the neck revealed high-grade kinking of the right internal carotid artery just underneath the mucosa of the pharyngeal wall. No medical or surgical intervention was performed. The condition was documented in the patient’s file to prevent future injury. Conclusion: Although uncommon, clinicians must consider the presence of aberrant internal carotid arteries in the neck, especially in elderly patients with a history of atherosclerosis who present with pulsatile tinnitus, dizziness, dysphagia, or sleep disorders. This anomaly carries a high risk of severe or fatal hemorrhage during neck surgery or endotracheal intubation and should be documented in the patient’s file.
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Raslan et al. (2026) conducted a case report in Aberrant cervical internal carotid artery presenting with pulsatile tinnitus (n=1). Contrast-enhanced CT of the neck and conservative management (documentation without intervention) was evaluated on Diagnosis and management of submucosal pulsatile posterior pharyngeal mass. Contrast-enhanced neck CT in a 69-year-old man with >2 years of pulsatile tinnitus identified high-grade right internal carotid artery kinking beneath the pharyngeal mucosa, managed conservatively.
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