Wandering carotid arteries: Reciprocating change between normal and retropharyngeal positions on serial CT studies

Abstract

Positional change in the retropharyngeal carotid artery, a rare phenomenon over time, is even rarer in previous reports, and it is important to be aware of this before any neck surgical procedure. A woman in her 50s underwent an anterior maxillectomy for upper gingival cancer, without neck dissection. The patient had medical histories of diabetes mellitus and liver dysfunction, with unremarkable family histories. Serial neck contrast-enhanced computed tomography for detecting locoregional recurrence had been performed as a follow-up during 4 years. A radiological course of moving carotid arteries in serial computed tomography studies showed reciprocating positional changes (wandering) between normal and retropharyngeal regions. There was no locoregional recurrence of the gingival cancer. This is the first case to describe a so-rare presentation of wandering carotid arteries. It is important for clinicians to be aware of a wandering carotid artery to avoid potentially fatal complications.

A rare case of positional changes of carotid artery depicted within a single MR study and a wandering carotid artery depicted on a serial MR studies

“…Nonetheless, the definitive cause of this phenomenon remains unconfirmed. In the eight cases reported so far, positional change was confirmed at the level from the hyoid bone to the suprahyoid bone [1] , [2] , [3] , [4] , [5] , which is consistent with our case. It has been previously suggested that the position of the hyoid bone may be related to changes in the position of the carotid artery [1] .…”

“…Wandering carotid artery is a rare condition in which reciprocal positional changes of carotid artery is observed on serial contrast-enhanced CT examinations, with only three previous cases including this case [ 4 , 5 ]. In our case, the right common carotid artery moved between medial and lateral (normal) position on three MR studies, and was considered as a wandering carotid artery.…”

“…There have been 8 cases of carotid artery position changes reported so far [1] , [2] , [3] , [4] , [5] . The incidence of positional changes of carotid artery in RCA is estimated to be 6.3% [3] .…”

“…The incidence of positional changes of carotid artery in RCA is estimated to be 6.3% [3] . Some causes of this positional changes are speculated to include atherosclerosis, gender (female), hypertension, advanced age, vascular tortuosity [5] , inadequacy of the carotid sheath fascia [ 1 , 4 , 5 ], respiratory movement [1] , swallowing [2] , neck extension during scanning [5] , decreased carotid artery tension and increased body mass index [5] . However, there is not enough evidence for any of these factors, and the detailed pathogenesis is remains unknown.…”

“…Several case studies reported that the position of the carotid artery changed from its normal position to the retropharyngeal space (RPS) or vice versa [ 1 , 2 , 3 ]. In addition, there are some reports of "wandering carotid artery" which means that the carotid artery reciprocate positional changes (wandering) between its normal position and retropharyngeal regions, during follow-up evaluations [ 4 , 5 ]. This is a first case which showed a rare clinical course of a wandering carotid artery on serial follow-up MR studies and positional changes of carotid artery within a single MR study.…”