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


CONCLUSIONS
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.
Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Y-Y
YY
Lin
C-H
CH
Wang
S-C
SC
Liu
H-C
HC
Chen
D002343:Carotid Artery, Internal / Q000002:abnormalities*; D003937:Diagnosis, Differential; D004432:Ear, Middle / Q000002:abnormalities* / Q000000981:diagnostic imaging; D046088:Hearing Loss, Unilateral / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007601:Jugular Veins / Q000002:abnormalities*; D018810:Magnetic Resonance Angiography; D008297:Male; D038781:Otoscopy; D011859:Radiography; D013701:Temporal Bone / Q000000981:diagnostic imaging; D014012:Tinnitus / Q000175:diagnosis* / Q000209:etiology; D057832:Watchful Waiting; D055815:Young Adult