Diagnosing and imaging of aberrant carotid and persistent stapedial Arteries: A rare cause of pulsatile tinnitus

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Congress:

ECR 2016

Poster Number:

C-1762

Type:

Educational Exhibit

Keywords:

Diagnostic procedure, MR-Angiography, CT-High Resolution, CT-Angiography, Head and neck, Ear / Nose / Throat, Education and training

Authors:

M. Gaha, O. fekih, H. Jemni, K. Tlili; Sousse/TN

DOI:

10.1594/ecr2016/C-1762

DOI-Link:

https://dx.doi.org/10.1594/ecr2016/C-1762

Fig. 1: CT Axial Images (A to H) : The small vascular channel can be seen leaving the...

Fig. 2: CT Coronal images (A to D) : the narrow presumed vascular structure is seen at...

Fig. 3: Axial (A, B) and coronal reconstruction (C) CT images of the left temporal bone...

Fig. 4: Axial source (A) and 3 D volume rendered MRA (B) images show duplication of the...

Fig. 5: Axial CT images of the right internal carotid canal dehiscence.

Fig. 6: Coronal reconstruction CT images of the right internal carotid canal dehiscence.

Fig. 7: Axial and Coronal reconstruction CT images of internal carotid canal bilateral...

Learning objectives

After reviewing this exhibit, the reader will be able to diagnose with confidence aberrant carotid and persistent stapedial arteries, which are less common, but important causes of pulsatile tinnitus.

Background

Aberrant carotid and persistent stapedial arteries are uncommon vascular anomalies related to the temporal bone.

Findings and procedure details

Arterial anomalies of the middle ear are rare but important to know because of their possible clinical implications. Three main anomalies are described: The persistence of stapedial artery Aberrant Internal Carotid artery in the middle ear The pharyngolaryngeal stapedial artery CLINICAL APPEARANCE: These anomalies have in common the presence of abnormal vessels. In the middle ear, they are frequently asymptomatic and discovered incidentally: Either on the otoscopy by the presence of a red retro-tympanic pouring mass Or on an imaging exam, visualization of abnormal vessel...

Conclusion

Aberrant carotid and persistent stapedial arteries are important diagnostic considerations in the differential diagnosis of pulsatile tinnitus in any age group. Preoperative diagnosis of these conditions will alert the surgeon to avoid potential intraoperative complications.

Personal information

References

Fabio A Thiers, Osamu Sakai, Dennis S. Poe, and Hugh D. Curtin Persistent Stapedial Artery: CT Findings Am J Neuroradiol 21:1551–1554, September 2000 Brian C Gartrell, Tabassum A Kennedy, Samuel P Gubbels Bilateral Duplicated Internal Carotid Arteries Presenting as Middle Ear Masses: A Case Report and Review of the Literature Ann Otol Rhinol Laryngol. 2012 August ; 121(8): 521–524.