Kissing Carotids

Findings:

Axial CT images demonstrate that the cavernous segments of the internal carotid arteries extend medially further than would be expected and abut at the midline. The internal auditory canals are also more anteriorly directed than typical. The overall findings are suggestive of central skull base hypoplasia.

Discussion:

"Kissing carotids" is the term used to identify an anatomic variant in which the carotid arteries are tortuous and elongated and come in close proximity at the midline. Although more common in the retropharynx, it is also possible to be seen retro-sphenoid, as in this patient. This variant is not pathologic, but may cause confusion with suprasellar pathology if not recognized. It is important to note this variant if there is the possibility of trans-sphenoidal or retropharyngeal surgery, as entering into these vessels would be catastrophic.

Case contributed by Christopher Heald, UC M4