Internal carotid artery in the middle ear
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A 6-year-old girl presented with a 1-year history of pulsatile tinnitus in her right ear. Pure-tone audiometry showed normal hearing. Otoscopy showed a whitish pulsatile mass behind the tympanic membrane in the anteroinferior quadrant of the middle-ear cavity. Computed tomography (CT) of the temporal bone revealed a vessel coursing through the hypotympanum (Panel A, arrow) and entering the carotid canal through a dehiscence in the carotid plate — a finding consistent with an aberrant right internal carotid artery. Normal structures in the left ear are shown for comparison, including the normal location of the internal carotid artery at this level within the carotid canal and an intact carotid plate. An aberrant internal carotid artery in the middle ear is a rare vascular anomaly. An aberrant internal carotid artery can mimic other middle-ear lesions, so it is important that imaging be performed before any surgical intervention in order to avoid bleeding complications that may result from misdiagnosis. The patient underwent surgical correction (Panel B)...

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