Abstract
Common carotid artery usually bifurcates at the superior border of thyroid cartilage, corresponding to the C3–4 junction, however bifurcation level may vary. Common carotid bifurcation may have rare variations like separate origins of left internal and external carotid arteries from aortic arch, or bifurcation of common carotid artery within thoracic cavity. Intrathoracic carotid bifurcation is a rare variation with limited number of cases reported. The occurrence of a low carotid bifurcation seems to be embryologically related to the persistence of the ductus caroticus. Additionally, intrathoracic carotid bifurcation can be accompanied by findings of Klippel–Feil syndrome. Herein, we present imaging findings of an incidentally detected intrathoracic left common carotid artery bifurcation in a pediatric patient accompanied by fusion of the cervical vertebrae and ribs.
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References
Bakheit MA, Gahatani FM (2014) Low bifurcation of the common carotid arteries: an anatomical and radiological study. East Mediterr Health J 19:227–228
Brill CB, Peyster RG, Keller MS, Galtman L (1987) Isolation of the right subclavian artery with subclavian steal in a child with Klippel–Feil anomaly: an example of the subclavian artery supply disruption sequence. Am J Med Genet 26:933–940
Brown CR, Brown MR (2017) Treatment of a symptomatic intrathoracic internal carotid artery. J Vasc Surg Cases Innov Tech 3:171–174
Cakirer S, Karaarslan E, Kayabali M, Rozanes I (2002) Separate origins of the left internal and external carotid Arteries from the aortic arch: MR angiographic findings. Am J Neuroradiol 23:1600–1602
Charalambous S, Hatzidakis A, Peteinarakis I, Megremis S, Karantanas A (2019) Common left carotid bifurcation at C7–Th1 level: a rare anatomical variant. Surg Radiol Anat 41:227–229
Elumalai G (2016) “Patent ductus caroticus” embryological basis and its clinical significance. Physiol Anat 98:42439–42442
Gailloud P, Murphy KJ, Rigamonti D (2000) Bilateral thoracic bifurcation of the common carotid artery associated with Klippel–Feil anomaly. Am J Neuroradiol 21:941–944
Gomez CK, Arnuk OJ (2013) Intrathoracic bifurcation of the right common carotid artery. BMJ Case Rep. https://doi.org/10.1136/bcr-2012-007554
Gulsen S, Caner H, Altinors N (2009) An anatomical variant: low-lying bifurcation of the common carotid artery, and its surgical implications in anterior cervical discectomy. J Korean Neurosurg Soc 45:32–34
Itabashi R, Yazawa Y, Shigehatake Y, Furui E (2018) A case of intrathoracic carotid bifurcation without Klippel–Feil syndrome. J Stroke Cerebrovasc Dis 27:15–16
Kau T, Sinzig M, Gasser J, Lesnik G, Rabitsch E, Celedin S, Eicher W, Illiasch H, Hausegger KA (2007) Aortic development and anomalies. Semin Interv Radiol 24:141–152
Lee JH, Oh CW, Lee SH, Han DH (2003) Aplasia of the internal carotid artery. Acta Neurochir (Wien) 145:117–125
Lo A, Oehley M, Bartlett A, Adams D, Blyth P, Al-Ali S (2006) Anatomical variations of the common carotid artery bifurcation. ANZ J Surg 76:970–972
Mohan CR, Sharp WJ, Hoballah JJ, Schueppert MT, Kresowik TF, Corson JD (1996) Intrathoracic bifurcation of the left common carotid artery with a symptomatic internal carotid artery stenosis: case report. Vasc Endovasc Surg 30:423–425
Nas OF, Karakullukcuoglu Z, Hakyemez B, Erdogan C (2016) Dissection of a non-bifurcating cervical carotid artery. Neuroradiol J 29:213–215
Rielly JP (2008) Intrathoracic carotid bifurcation in Klippel–Feil syndrome. J Vasc Surg 47:1071–1073
Sudhakar AS, Nguyen VT, Chang JB (2008) Klippel–Feil syndrome and supra-aortic arch anomaly: a case report. Int J Angiol 17:109–111
Al Tsirikos, McMaster MJ (2005) Congenital anomalies of the ribs and chest wall associated with congenital deformities of the spine. J Bone Jt Surg Am 87:2523–2536
Uzun L, Kokten N, Kilicaslan A, Tasel B, Kalcioglu MT, Tekin M (2013) Bilateral lower cervical bifurcation of the common carotid artery. Case Rep Otolaryngol 2013:1–3
Vitek JJ, Reaves P (1973) Thoracic bifurcation of the common carotid artery. Neuroradiology 5:133–139
Zumre O, Salbacak A, Cicekcibasi AE, Tuncer I, Seker M (2005) Investigation of the bifurcation level of the common carotid artery and variations of the branches of the external carotid artery in human fetuses. Ann Anat 187:361–369
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Kandemirli, S.G. Intrathoracic bifurcation of the left common carotid artery associated with rib fusion and Klippel–Feil syndrome. Surg Radiol Anat 42, 411–415 (2020). https://doi.org/10.1007/s00276-019-02338-0
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DOI: https://doi.org/10.1007/s00276-019-02338-0