# Symptomatic Bilateral Aberrant Course of the Internal Carotid Arteries Presented as a Non-pulsatile Mass in the Posterior Pharynx: A Case Report and Literature Review

## TL;DR

A rare case of abnormal carotid artery placement causing throat issues is reported, highlighting risks during medical procedures.

## Contribution

This case report adds to the literature on rare carotid artery variations and their clinical implications.

## Key findings

- A 76-year-old male had a non-pulsatile mass in the posterior pharynx due to aberrant carotid arteries.
- Computed tomography angiography confirmed retropharyngeal routing of the common carotid arteries.
- Such anatomical variations pose risks during pharyngeal procedures like intubation or NGT insertion.

## Abstract

The atypical congenital pathway of the internal carotid artery (ICA) is an uncommon anatomical variation with a very low prevalence. The medialization of the internal carotid artery is regarded as an infrequent manifestation. The internal carotid artery may be displaced at the level of the pharyngeal wall, leading to the enlargement of connective tissue in the lateral pharynx and retropharyngeal areas. A 76-year-old male patient with a history of weakness on the left side of his body, difficulty swallowing, and speech difficulties was sent to the otorhinolaryngology department because of pain in his throat. He underwent several unsuccessful attempts at the insertion of a nasogastric tube (NGT), which was eventually done with considerable difficulty.

Upon evaluation, the individual displayed regular speech and a strength rating of 4/5 in both of his left limbs. Upon examination of the throat, a significant non-pulsating edema was observed in the right retropharyngeal area, pushing the right tonsil anteromedially. A posterior pharyngeal mass was observed during fiberoptic laryngoscopy. The Doppler examination of the carotid arteries yielded definitive results. Computed tomography angiography (CTA) showed the common carotid arteries via a retropharyngeal route. It is clinically significant to identify variations in the course of the internal carotid artery, particularly those located near the submucosal area of the pharynx. This is because there is a higher risk of injury during procedures involving manipulation of the pharynx, such as intubation, insertion of a nasogastric tube, or surgeries in the internal carotid artery region.