Kissing carotids: An unusual cause of dysphagia in a healthy child.

A 12-year-old previously healthy girl presented with insidious onset, slowly progressive difficulty in swallowing, which was more with solids. There was no history of pain on deglutition, chest pain, foreign body sensation in throat, change in voice, heartburn, and choking or coughing during swallowing. Her systemic examination was also noncontributory. Examination of the throat revealed a smooth, pulsatile bulge on the posterior wall of oropharynx. Contrast-enhanced computed tomography revealed ectatic bilateral common carotid arteries in the retropharyngeal region near the midline with a minimum distance of 1.0 mm in between them from C4 to C6 vertebral level [Figure 1a and b]. Bilateral internal jugular veins also appeared slightly medially displaced. Thus, a diagnosis of “kissing carotids” was made.

Figure 1

Axial (a) and coronal (b) contrast-enhanced computed tomography images showing ectatic medially displaced bilateral common carotid arteries in the cervical region at C4 to C6 vertebral level

Anatomical variations of the extracranial internal carotid arteries (ICA) occur in 5%–6% of the general population.[1] The cervical part of the ICA (pars cervicalis) reveals following three major abnormalities in route-tortuosity, kinking, and coiling.[2] The term “kissing carotid aneurysm” refers to bilateral carotid artery aneurysms which meet in the midline. Depending on the location, this anomaly may lead to different clinical consequences:[2] transient ischemic attacks, stroke, hormonal dysfunction, cerebral hypoperfusion, sudden death, and prevertebral swelling mimicking fracture.[3] Most of the cases are incidental intraoperative or radiological findings.[4]

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