Korean J Radiol.  2016 Aug;17(4):554-557. 10.3348/kjr.2016.17.4.554.

A Case of Anomalous Origin and Course of Vertebral Artery in a Patient with Klippel Feil Syndrome

• Ulusoy OL
• Sasani H
• Barlas SB
• Mutlu A
• Sasani M

• KMID: 2455426
• DOI: http://doi.org/10.3348/kjr.2016.17.4.554

Abstract

Patients with Klippel-Feil syndrome (KFS) have an increased incidence of vascular anomalies as well as vertebral artery (VA) anomalies. In this article, we presented imaging findings of a 15-year-old female patient with KFS with a rare association of extraforaminal cranially ascending right VA that originated from the ipsilateral carotid bulb. Trifurcation of the carotid bulb with VA is a very unusual variation and to the best of our knowledge, right-sided one has not been reported in the literature.

Keyword

Carotid bulb; Vertebral artery; Trifurcation; Klippel-Feil syndrome

MeSH Terms

Adolescent
Aorta, Thoracic/abnormalities/diagnostic imaging
Computed Tomography Angiography
Female
Humans
Imaging, Three-Dimensional
Klippel-Feil Syndrome/*diagnosis/diagnostic imaging/etiology
Tomography, X-Ray Computed
Vascular Malformations/complications
Vertebral Artery/abnormalities/*diagnostic imaging

Figure

• 

  Fig. 1 3D CT demonstration of anomalous right VA. 3D volume rendered CT (A), coronal (B), axial (C), and sagittal (D) maximum intensity projection CT images show right vertebral artery originating from carotid bulb. Internal carotid artery (white arrow in A and B), external carotid artery (black arrows in A), vertebral artery (arrowheads in A and B). Images show course of right vertebral artery (arrows in C and D) in prevertebral location, its ascending in foramen magnum anteriorly without entering any transverse foramen. Right and left internal carotid arteries (arrowheads in C). VA = vertebral artery, 3D = three-dimensional

• 

  Fig. 2 Schematic illustration aortic arch system. A. Normal embryologic development. Horizontal parts of first six CIAs disappear on involution, bilateral regression of DC separates common carotid arteries from subclavian artery on right side and from aortic arch on left side. Aortic arches (I–VI) are illustrated. PPPA provide proximal supply to longitudinal neural arteries. B. Normal anatomy in adults: longitudinal connections linking intersegmental arteries that further form VA bilaterally from ipsilateral subclavian arteries, which are derived from seventh intersegmental arteries. AoArch = aortic arch, BA = basilar artery, CCA = common carotid artery, CIAs = cervical intersegmental arteries, DC = ductus caroticus, ECA = external carotid artery, ICA = internal carotid artery, LScA = left subclavian artery, PPPA = primitive proatlantal intersegmental arteries, RScA = right subclavian artery, VA = vertebral artery

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