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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)
  • DOI: http://dx.doi.org/10.1017/S0022215112000564
  • Published online: 19 April 2012
Abstract
AbstractObjective:

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.

Copyright
Corresponding author
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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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

3M Botma , RA Kell , J Bhattacharya , JA Crowther . Aberrant internal carotid artery in the middle-ear space. J Laryngol Otol 2000;114:784–7

4E Sauvaget , J Paris , S Kici , R Kania , JP Guichard , R Chapot Aberrant internal carotid artery in the temporal bone: imaging findings and management. Arch Otolaryngol Head Neck Surg 2006;132:8691

5S Koesling , P Kunkel , T Schul . Vascular anomalies, sutures and small canals of the temporal bone on axial CT. Eur J Radiol 2005;54:335–43

6CH Wang , ZP Shi , DW Liu , HW Wang , BR Huang , HC Chen . High computed tomographic correlations between carotid canal dehiscence and high jugular bulb in the middle ear. Audiol Neurootol 2011;16:106–12

7RL Ruggles , RC Reed . Treatment of aberrant carotid arteries in the middle ear: a report of two cases. Laryngoscope 1972;82:1199–205

8BR Huang , CH Wang , YH Young . Dehiscent high jugular bulb: a pitfall in middle ear surgery. Otol Neurotol 2006;27:923–7

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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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