Salvatore Ferlito*, Milena Di Luca*, Antonino Maniaci*, Federica Cipolla*, Ignazio La Mantia*, Luigi Maiolino*, Agata Ferlito**, Salvatore Cocuzza*, Calogero Grillo*


*Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section; University of Catania, Italy     

**Department of Medical Surgical Sciences and Advanced Technologies - Radiology I Unit, University of Catania, Catania, Italy 


Introduction: Anomalous cervical carotid artery pathway represents an unknown risk factor for massive bleeding during pharyngeal surgery and intubation. It is often found incidentally in totally asymptomatic patients undergoing radiographic studies for unrelated reasons or patients who have respiratory diseases, cough and difficulty swallowing or undergoing pharyngeal surgery for other pathology.  

Case presentation: We describe a 48-year-old woman who presented chronic cough, feeling of a lump in the throat and progressive dysphagia. Endoscopic examination demonstrated an evident pulsatile mass protruding inside its retro pharynx. Three-dimensional MDCT angiography and Doppler ultrasonography performed accurate images allowing the accurate assessment of these vascular anomalies.

Conclusion: Evaluation of pulsating hypopharynx mass should include differential diagnosis with retropharyngeal abscess or tumorous lesion. The association of an abnormal pathway is highly correlated with the onset of neurological symptoms, an increased risk of bleeding and stroke. Therefore, where it is not possible to follow the patient's condition due to severe associated complications, resection and surgical correction of the affected vascular segment is indicated.


Cervical carotid artery, variant anatomy, pharynx, aberrant.