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

The retropharyngeal carotid artery (RCA) is a relatively rare anatomical malposition, and positional changes in the RCA is also extremely rare. 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. A male patient in his 50s with a chief complaint of globus pharyngeus. A pulsatile swelling of the posterior pharyngeal wall of the right side was found on clinical examination. In this case, the right carotid artery showed the clinical course of a wandering carotid artery, which reciprocated between its normal position and the retropharyngeal space during three serial MR investigations. Interestingly, both the most recent MR study and the MR study performed 4 years ago showed that the carotid artery at the level of the hyoid bone moved laterally (positional normalization) during the single MR investigation. 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. It is important for clinicians to be aware of these phenomena, in order to avoid fatal and unexpected complications during clinical procedures.     

A rare combination of carotid artery congenital abnormalities: understanding the embryology and clinical associations

Duplication of an extracranial internal carotid artery, a retropharyngeal carotid transposition, an aberrant internal carotid artery in the middle ear, and a persistent stapedial artery are each individually uncommon vascular variants. In this case report, we discuss a rare occurrence of all four of these variants in a single individual who presented to our emergency department with a complaint of dizziness and a recent fall. Included in the discussion is pertinent embryology and clinical associations.     

Syncope as a sign of occult malignant recurrence in the retropharyngeal and parapharyngeal space: CT and MR imaging findings in four cases

Although rare, syncope may result from metastasis to the retropharyngeal or parapharyngeal space and involve or invade the glossopharyngeal nerve or internal carotid artery. We report the CT and MR imaging findings in four patients with syncope that preceded the diagnosis of recurrent squamous cell carcinoma in the pericarotid region. These findings suggest that recurrent carcinoma should be ruled out when a patient with head and neck malignancy and syncope is postoperatively examined.     

Infrahyoid spread of deep neck abscess: anatomical consideration

The aim of this study was to determine the pathway of infrahyoid extension of the oropharyngeal abscess considering the anatomy of the fascial spaces by cross-sectional imaging. CT scans and MR images were retrospectively reviewed in ten patients with known infrahyoid extension of oropharyngeal abscesses (eight with acute tonsillitis, two with acute phlegmonous oropharyngitis). In seven of eight patients tonsillar abscesses descended along the deep cervical fascia converging on the hyoid bone and further accumulated in the anterior cervical space through which extension to the mediastinum took place in four patients. In seven patients the abscesses involved the retropharyngeal space at the infrahyoid neck. In two of these seven patients the abscesses directly extended down into the upper mediastinum through the retropharyngeal space. In one patients of the seven mediastinal spread of an abscess occurred through the posterior cervical space, not through the retropharyngeal space. Cross-sectional imaging is valuable in the evaluation of deep neck abscesses and the pathway of spread. The anterior cervical space in the infrahyoid neck is important for mediastinal extension of pharyngeal abscesses. Received: 10 April 1997; Revision received 23 October 1997; Accepted 12 January 1998     

An early MR observation of carotid involvement by retropharyngeal abscess.

We report early carotid involvement by retropharyngeal abscess in a 4-year-old boy. MR imaging showed enhancement of the wall and narrowing of the lumen of the internal carotid artery, which were thought to reflect spasm and/or arteritis. Prompt treatment may have prevented hemorrhagic and neurologic complications.     

Moyamoya disease mimicking a spontaneous internal carotid artery dissection on Doppler ultrasound

Moyamoya disease and spontaneous internal carotid artery dissections are rare conditions, but both tend to affect young adults with potentially devastating consequences. A 43-year-old non-Japanese patient presented with neurological symptoms, which, following carotid Doppler ultrasound and angiography, was labelled as being due to a spontaneous internal carotid artery dissection. Repeat imaging at 3 months showed normalisation of the carotid Doppler findings which coincided with the formation of „moyamoya” vessels on the angiogram. This case report illustrates the changes on carotid ultrasound in early moyamoya disease which may mimic the appearances of an internal carotid artery dissection and demonstrates the change of the spectral Doppler waveform that occurs with the formation of new vessels at the base of the brain. Received: 20 August 1998; Revision received: 23 November 1998; Accepted: 23 December 1998     

Peripatetic carotid artery simulating a carotid dissection on catheter angiography and CT angiography: a case report

Retropharyngeal carotid arteries are a common clinically relevant anatomic variant. “Peripatetic” carotid arteries refer to change in position to and from a retropharyngeal location, and are a newly described finding. Knowledge of this phenomenon is important to avoid potential procedural complications as well as misdiagnosis. We present a unique case of a peripatetic carotid artery simulating a carotid artery dissection during a catheter angiogram and subsequent CT angiogram. To our knowledge, this has never been described in the medical literature.     

舌骨上颈部筋膜间隙MR成像

目的：研究舌骨上 部艋膜间隙及其内容物。方法：使用自旋回波T2WI和快速自旋回波T2WI序列,以横轴位为主,结合撩状位及冠状位进行观察,结果：舌骨上颈部的筋膜间隙包括下颌下间隙,咽粘膜间隙,咽后间隙,椎周间隙,咽旁间隙,颈动脉间隙,咀喟间隙,腮腺间隙和颈后间隙,下颌下间隙位于颈前下方,咽粘膜间隙,咽后间隙,椎周间隙位居中线,在横轴位上呈前后排列,咽旁间隙,颈动脉间隙,咀嚼间隙,腮腺间隙和颈后间隙对称性分布于颈椎两侧,颈后间隙位于椎体后外方,结论：MRI可清晰显示舌骨上颈部筋膜间隙,划分筋膜间隙有利于疾病的定位,有助于病变的诊断与鉴别诊断。     

Nasopharyngeal carcinoma: MRI and CT assessment

Precise assessment of the extent of nasopharyngeal carcinoma (NPC) represents the basic step towards optimal treatment. We compared the capacity of CT and MRI in assessing the extent of NPC in 67 patients. MRI was superior to CT in demonstrating lesions in the retropharyngeal node, skull base, intracranial area, carotid space, longus colli muscle and levator palatini muscle. Of 25 cases in which retropharyngeal adenopathy was recognised only on MRI, seven had been reported as showing oropharyngeal involvement and 18 as primary extension to the carotid space on CT. MRI showed skull-base involvement in 40 patients compared with 27 on CT and intracranial involvement in 38 patients versus 24 on CT. There was not a single case in which skull base invasion was seen on CT but not on MRI. MRI enabled improved recognition of tumour infiltration of longus colli muscles (34 cases compared with 15 on CT). It allowed us to clarify 12 questionable sinonasal opacities on CT. Overall, T-staging was changed in 18 of 67 patients (26.9 %), including upstaging in 15 cases and downstaging in 3 cases, after comparing CT with MRI. The nodel status was changed from negative on CT to positive on MRI in 4 of 67 patients (6 %). We believe that MRI allows more accurate evaluation of the extent of NPC than CT and should be the primary mode of investigation. Received: 18 November 1996 Accepted: 22 January 1997     

CTA综合评价颈动脉鞘占位病变与颈动脉的关系

目的：探讨颈动脉多层螺旋CT血管造影(CTA)和多种后处理技术在分析颈动脉鞘占位病变与颈动脉关系中的应用价值。方法：回顾分析30例颈动脉鞘肿块患者的CTA轴位和MPR，SSD，MIP，VR，VE(仿真内镜)等后处理图像，根据肿瘤与血管交角(瘤-管角)、瘤-管脂肪间隙、颈动脉狭窄的程度、血管壁光滑度等4项指标评价颈动脉鞘占位与颈动脉的关系。结果：CTA后处理共获得60支血管，有10支颈动脉受侵犯，9支为恶性肿瘤所致，l例为脓肿所致。将轴位和后处理图像相结合，综合运用4项指标有助于显示颈动脉鞘占位与颈部血管关系，可帮助判断颈动脉受侵与否。结论：CTA后处理方法综合运用能良好显示颈动脉鞘占位与颈部血管关系，有助于术前判断占位是否侵犯颈动脉，具有重要的临床价值。     

颈部神经源肿瘤的CT诊断

目的：探讨ＣＴ扫描对颈部神经源肿瘤的定位、定性诊断价值。材料与方法：复习经手术及病理证实的颈部神经源肿瘤的ＣＴ扫描３０例,包括神经鞘瘤１７例,神经纤维瘤６例,颈动脉体瘤３例,恶性神经源肿瘤４例。结果：肿瘤位于颈动脉间隙１５例,椎旁间隙９例,其他部位６例。颈动脉间隙肿物中,８例（５３．３％）使颈动、静脉向外侧移位,２例（１３．３％）使血管向前方移位,５例（３３．３％）使颈动、静脉分离（其中４例明确来     

Pseudoaneurysm of the internal carotid artery after shrapnel injury in World War II: demonstration by CT angiography with 3D MIP reconstruction

A case of pseudoaneurysm of the left internal carotid artery (ICA) after shrapnel injury is demonstrated by intra-arterial digital subtraction angiography (DSA) and computed tomography angiography (CTA) with subtraction technique. Although the pseudoaneurysm was well demonstrated by intra-arterial DSA, CTA was the only modality to demonstrate the three-dimensional shape of the perfused part of pseudoaneurysm and the aneurysmal neck, which affected the therapeutic strategy. The CTA technique is useful in the assessment of large pseudoaneurysms and for therapeutic planning. Received: 2 July 1998; Revision received: 5 November 1998; Accepted: 7 December 1998     

Long-term 3T MR angiography follow-up after therapeutic occlusion of the internal carotid artery to detect possible de novo aneurysm formation

BACKGROUND AND PURPOSE: The purpose of this study was to assess the incidence of de novo aneurysm formation, the incidence of subarachnoid hemorrhage (SAH), and the growth of existing untreated aneurysms in 52 patients after therapeutic carotid artery balloon occlusion for carotid aneurysms. PATIENTS AND METHODS: Between January 1996 and August 2004, 52 patients were treated with carotid artery balloon occlusion for carotid aneurysms. In June 2005, all patients, their next of kin, or family physicians were contacted and questioned concerning episodes of headache or hospital admissions that could be attributed to SAH. In addition, MR imaging and MR angiography (MRA) at 3T were performed in 26 of 44 surviving patients after a mean follow-up period of 50.2 months (median, 43.5 months; range, 14-107 months). MR imaging and MRA studies were compared with the digital subtraction angiograms at the time of carotid artery occlusion. RESULTS: During clinical follow-up of 52 patients at a mean of 50.3 months (median, 42.5 months; range, 0-107 months), no episodes of SAH were reported (0%; 97.5% confidence interval [CI], 0-8.2%). In the 26 patients with follow-up MR imaging, no de novo aneurysms were detected (0%; 97.5 CI, 0-13.2%). Five existing untreated small aneurysms in 5 patients had not enlarged after a mean follow-up of 40 months. CONCLUSION: In this study, therapeutic carotid artery occlusion was not associated with development of new aneurysms or enlargement of existing untreated aneurysms with time.     

A case of intracranial vasospasm in a patient with extensive retropharyngeal cellulitis

Retropharyngeal cellulitis/abscesses are deep neck infections that may become life-threatening if airway compromise occurs. This condition is more common in children than in adults, and associated intracranial vessel narrowing has been reported. We report an adult patient with extensive retropharyngeal cellulitis and intracranial vasospasm. The patient was a 62-year-old woman who presented with fever, sore throat, and neck pain. She also had uncontrolled type 2 diabetes mellitus. Leukocytosis, prolonged erythrocyte sedimentation rate, elevated C-reactive protein, and hyperglycemia were present on admission. Computed tomography and contrast-enhanced magnetic resonance imaging revealed severe swelling in the nasopharyngeal, retropharyngeal, prevertebral, and bilateral carotid spaces. Gadolinium enhancement extended to the middle cranial fossa and visceral space. Multiple stenoses in several intracranial vessels was also identified. Intravenous antibiotic therapy was initiated, the patient''s symptoms resolved, and repeat imaging confirmed improvement. Intracranial vasospasm should be considered in patients with retropharyngeal cellulitis.     

Failure to demonstrate a direct caroticocavernous fistula due to arterialisation of the ipsilateral cavernous sinus

We report a woman in whom a small direct caroticocavernous fistula (DCCF) was revealed after successful transarterial occlusion of a contralateral fistula which drained into both cavernous sinuses. We underline that a second smaller fistula can be masked by a contralateral larger one due to the lack of pressure gradient between the internal carotid artery (ICA) and arterialised blood in the ipsilateral cavernous sinus. We suggest that bilateral ICA angiograms should be performed before and after occlusion of all DCCF. Received: 21 January 1998 Accepted: 12 May 1998     

咽后椎前区肿瘤及肿瘤样病变的CT、MRI诊断

目的分析咽后椎前区肿瘤的CT和MRI特点,并探讨其临床价值。资料与方法回顾分析经病理证实的18例咽后椎前区肿瘤的CT、MRI特点,着重分析咽后壁、咽后脂肪、椎前肌及椎体的改变。结果18例中,咽后壁肿瘤1例,为神经鞘膜瘤;咽后间隙肿瘤5例,均为鼻咽癌;椎前间隙肿瘤12例,包括脊索瘤7例,脑膜瘤3例,外周原始神经外胚层肿瘤和软组织内动脉瘤样囊肿各1例。咽后壁肿瘤将咽后间隙脂肪推向后方,将椎前肌碾平或推向外侧;咽后间隙肿瘤位于咽后壁和椎前肌之间,将椎前肌推向后或内侧;椎前间隙肿瘤与椎体关系密切,将椎前肌和咽后脂肪推向前方。结论CT、MRI检查有助于判断咽后椎前区肿瘤的起源部位,提高诊断准确性。     

MR studies of extension and spread pattern of nasopharyngeal carcinoma

Seven patients with T2-T4 nasopharyngeal carcinoma were examined by MRI on a 0.5T superconducting system. The obtained MRI images were reviewed focusing on the signal intensity (SI) of tumors, and the extension of tumors into the related spaces from the pharyngeal mucosal space (PMS). Consequently, the SI of tumors demonstrated low on T1 weighted images and high on T2 weighted images. The parapharyngeal space was the first space where the tumors extended from the pharyngeal mucosa. The parapharyngeal space was an intermediate point of extension to the masticator space (MS), the carotid space (CS), the retropharyngeal space (RPS), and the prevertebral space (PVS). The PVS involvement by tumors was not a direct extension from the PMS, because the posterior portion of pharyngobasilar fascia worked as a barrier on MR. Therefore, the longus capitus muscle in the prevertebral space was considered to be involved via the parapharyngeal space (PPS). The masticator space involvement was indicated by slightly high SI of pterygoid muscle on T2 weighted images, and also the effacement of the PPS fat and parapharyngeal venous plexus were considered as a sign of involvement into the masticator space. The retropharyngeal lateral lymph node (Rouviere) metastases were recognized by MR. These metastasized lymph nodes were low on T1 weighted images and high on T2 weighted images.     

Multiplanar CT and MRI of collections in the retropharyngeal space: is it an abscess?

OBJECTIVE: The purpose of this article is to describe a practical imaging approach to evaluating collections in the retropharyngeal space. CONCLUSION: The differential diagnoses for fluid in the retropharyngeal space include both noninfectious and infectious processes. The multiplanar capabilities of CT and MRI are ideal for characterizing and delineating collections. In this pictorial essay, we describe the anatomy of the retropharyngeal space and offer a four-step approach to evaluating retropharyngeal collections on multiplanar imaging.     

Congenital arterial anomaly in the middle ear presenting as a glomus tumor.

A case of congenital agenesis of the cervical internal carotid artery with rerouting via the inferior tympanic artery and the embryonic hyoid artery to the horizontal internal carotid artery is presented. At otoscopy the anomaly simulated a glomus tumor. CT scan, by demonstration of the absence of the vertical portion of the carotid canal, the enlargement of the inferior tympanic canaliculus, and the soft tissue mass within the middle ear in continuity with the horizontal internal carotid artery, diagnosed the anomaly very accurately.