RESUMEN
BACKGROUND: Hypoplasia of the internal carotid artery is a rare congenital malformation. It has been mainly associated with aneurysms and other pathologies but not in association with paraganglioma. The incidence is 0.01% of all the anomalies of carotid vessels. Although the exact cause is unknown, it is thought to represent a sequel to an insult due to mechanical causes or hemodynamic stress but perhaps also involves aspects of molecular biology of embryonic development. CLINICAL CASE: We describe the case of a 37 year-old female patient with paraganglioma associated with hypoplasia of the internal carotid artery, which was found incidentally during surgery. Previous angiographic studies as well as other analyses were carried out, but we failed to detect hypoplasia of the internal carotid artery. Tumor was removed along with ligation of the external carotid artery due to injury. The hypoplastic internal carotid artery was left intact. CONCLUSION: Angiographic studies of the base of the skull are important as well as hemodynamic analysis in order to not overlook these anomalies. The patient had a satisfactory evolution without sequelae.
Antecedentes: la hipoplasia de la arteria carótida interna es una rara malformación congénita. Se le ha relacionado principalmente con aneurismas y otros padecimientos, pero no con paraganglioma. Su incidencia es menor de 0.01% de todas las anomalías de los vasos carotídeos. Aunque su origen exacto no se conoce, se cree que es una secuela de una lesión provocada por causas mecánicas o por estrés hemodinámico; sin embargo, también pudieran estar implicados aspectos de biología molecular del desarrollo embrionario. Caso clínico: se describe un caso raro de una mujer de 37 años de edad con paraganglioma concomitante con hipoplasia de la arteria carótida interna. En estudios angiográficos y análisis rutinarios previos no se había detectado alteración de la arteria carótida interna. En la intervención se extirpó el tumor y se ligó la arteria carótida externa dado que estaba involucrada en la lesión; se dejó intacta la arteria carótida interna hipoplásica. Conclusión: es importante realizar estudios angiográficos de la base del cráneo, así como análisis hemodinámicos para no pasar por alto estas anomalías. La evolución fue satisfactoria y sin secuelas.
Asunto(s)
Arteria Carótida Interna/anomalías , Tumor del Cuerpo Carotídeo/patología , Adulto , Arteria Carótida Externa/embriología , Arteria Carótida Externa/cirugía , Arteria Carótida Interna/embriología , Tumor del Cuerpo Carotídeo/fisiopatología , Tumor del Cuerpo Carotídeo/cirugía , Angiografía Cerebral , Anomalías Congénitas/embriología , Anomalías Congénitas/epidemiología , Femenino , Hemodinámica , Humanos , Incidencia , Hallazgos Incidentales , Ligadura , Imagen por Resonancia MagnéticaRESUMEN
INTRODUCTION: Hypoplasia of the internal carotid artery (HICA) is a rare congenital anomaly caused by an incomplete development of the organ, and only a few cases are reported in the literature. The prevalence of HICA (including agenesia and aplasia) is estimated to about 0.01%. CASE REPORT: We describe a case of a 66-year-old man with hearing loss on the left side and no other symptoms or signs related to vascular impairment. HICA was discovered incidentally by color duplex sonography of the extracranial cerebral vessel and confirmed by magnetic resonance imaging angiography (angio MRI) and computed tomography (CT) of the head. DISCUSSION: Compensatory flow allows HICA patients to remain asymptomatic, but complications may occur. The pathways of the collateral circulation in association with aplasia or HICA are described. A differential diagnosis was made on the basis of ultrasonographic (US) detection of diffuse luminal narrowing of the internal carotid artery (ICA). Recognition of this disease has important clinical implications.