Tortuous Carotid Artery

Epidemiology

The retropharyngeal space may be widened by a variety of pathological processes such as abscesses, hematoma, and edema. Medially deviated carotid arteries may also widen the retropharyngeal space but this phenomenon is rare and is usually found in the elderly.

Clinical Findings

Tortuous carotid arteries with medial deviation are usually detected as incidental findings. However, in patients with suspected cervical spine trauma, widening of the retropharyngeal space on a lateral cervical radiograph is often worrying. In such patients further evaluation is usually required to rule out cervical spinal injury.

Pathology

The cause of medial deviation of the carotid arteries is unknown. It may be congenital but is likely to be related to arteriosclerosis. In the elderly, arteriosclerosis results in elongation and migration of the affected artery. In the neck, this elongation leads to migration of the artery into adjacent spaces such as the retropharyngeal space.