J Korean Soc Radiol.  2014 Oct;71(4):169-172. 10.3348/jksr.2014.71.4.169.

Aberrant Internal Carotid Artery in the Middle Ear

• Roh KT
• Kang H

• KMID: 2098000
• DOI: http://doi.org/10.3348/jksr.2014.71.4.169

Abstract

The knowledge about the aberrant internal carotid artery (ICA) in the middle ear is essential for clinicians, because a misdiagnosis of the aberrant ICA could have serious consequences such as excessive aural bleeding during a middle ear surgery. A 38-year-old woman presented with tinnitus and hearing difficulties of the left ear that had started 5 years ago. During otoscopy, an anteroinferior bluish mass was seen in the tympanic space. Computed tomography and magnetic resonance imaging demonstrated a left-side aberrant ICA with bony dehiscence of the carotid canal in the middle ear and a reduced diameter of the tympanic ICA. Herein we report a case of an aberrant ICA in the middle ear. We also review the literature regarding this important vascular anomaly of the temporal bone which may lead to disastrous surgical complications.

MeSH Terms

Adult
Carotid Artery, Internal*
Diagnostic Errors
Ear
Ear, Middle*
Female
Hearing
Hemorrhage
Humans
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Otoscopy
Temporal Bone
Tinnitus

Figure

• 

  Fig. 1 38-year-old female with tinnitus and hearing difficulty of the left ear history. A. At otoscopy, an anteroinferior bluish mass in the left tympanic space is seen. B. Axial high resolution temporal bone CT scan shows the aberrant left ICA (white arrow), entering the tympanic cavity through a dehiscent carotid plate. C. The left ICA (white arrow) is seen entering the tympanic cavity through the markedly enlarged inferior tympanic canaliculus (Jacobson canal) on coronal temporal bone CT. D. Curved multiplanar reformation CT carotid angiography shows the aberrant left ICA, crossing the cochlear promontory and projected into the tympanic space. E. MRA shows a reduced diameter of the left tympanic ICA (white arrow). The vertical segment of the left ICA is lateral to a line drawn vertically through the vestibule. The aplasia of the A1 segment of the left ACA is revealed. Note.-ACA = anterior cerebral artery, ICA = internal carotid artery, MRA = magnetic resonance angiography

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