Congenital Kinking of the Internal Carotid Artery in Twin Brothers
We report magnetic resonance (MR) angiographic evidence of congenital kinking of the internal carotid artery in 4-year-old twin brothers. The first twin presented with a left pulsating laterocervical mass ≈2 cm in diameter. On examination, the mass had a palpable thrill and a systolic murmur. An echo-Doppler examination showed a loop of the left internal carotid artery with no hemodynamic changes. MR angiography disclosed a left internal carotid artery loop with kinking just after the bifurcation. No arteriovenous fistula was noted (Figure 1⇓.)
The second twin was completely asymptomatic. Clinical examination was normal, but an echo-Doppler examination revealed carotid loops on both sides, especially the right, with no hemodynamic changes. MR angiography showed kinking of the right internal carotid artery with a very acute internal angle close to the tonsil. The left carotid presented with an S-shaped tortuosity. No arteriovenous fistula was noted (Figure 2⇓). We decided not to treat these patients surgically.
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