Images in Clinical Medicine
Kinked Carotids
N Engl J Med 2010; 362:448February 4, 2010
- Article
An 80-year-old woman presented with congestive heart failure due to aortic insufficiency associated with a markedly dilated ascending aorta. On physical examination, she was noted to have a pulsatile mass in her neck that she reported had been present for more than a decade (Panel A). A three-dimensional reconstruction obtained from data from a computed tomographic angiogram (Panel B, and Figure 1 in the Supplementary Appendix [available with the full text of this article at NEJM.org]) revealed bilaterally kinked common carotid arteries. Kinks — or acutely angled bends — in carotid arteries can be seen in up to 5% of carotid angiograms obtained in symptomatic patients, though they are rarely apparent on physical examination. This patient had no neurologic symptoms and no increased blood-flow velocities, as measured by carotid Doppler; therefore, no surgical intervention was performed. Marked tortuosity and kinking of the carotid arteries is described most frequently in women and in the elderly and is often attributed to systemic hypertension. Long-standing aortic insufficiency with a resultant high pulse pressure might also have been a contributing factor in this patient.
Robert L. Rosenthal, M.D.
Bradley R. Grimsley, M.D.
Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX
robert.rosenthal@heartplace. com
