Abnormally curved and tortuous internal carotid artery : USG & Doppler

A  male child of about 7years of age presented with  a left sided  pulsatile  neck swelling  along upper anterior margin of SCM muscle  on clinical examination. On B-mode ultrasound the lesion appeared to be an abnormal anteriorly curved tortuous course of proximal left internal carotid artery  at its origin from common carotid artery . The curved vascular  course is slightly bulging superficially  to abutt & indent skin,corresponding the site of pulsatile swelling.  The lesion was confirmed to be vascular on color Doppler, & showed low resistance blood flow pattern on spectral display [ ICA pattern]. No abnormal luminal dilatation or mural plaque or thrombotic  lesion revealed in it. The common carotid & external carotid arteries were seen normally . No any other neck abnormality was detected . In view of these ultrasound & color Doppler findings the diagnosis of uncomplicated  “ abnormally curved & Tortuous  internal carotid origin” was made which appeared to be as pulsatile neck swelling . Case by –Dr.Subhash Tailor, M.D.[Radiodiagnosis] Bhilwara [Rajasthan, India]

Fig 1 – TS US Image left upper neck shows  tortuous bulging echopoor area [arrows]with mobile low level internal echos, at the level of bifurcation of left CCA

Fig 2-  B-mode & color Doppler US images shows , the lesion to be vascular & abnormally  bulging tortuous curved course of origin of left internal carotid artery passing posterolaterally

Fig 3 – spectral signals in the vessel appears  like that of ICA pattern

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Comments
The tortuous ICA is probably an angiodysplasia likely fibromuscular dysplasia. The ICA is the 2nd most affected artery after the renal artery. Patient needs evaluation by panaortography with special focus on renal arteries.

Regards

Dr Sandeep Kawlra
Director Radiology
Nairobi, Kenya