A Case Report of Fish bone Ingestion Masquerading an Aberrant Internal Carotid Artery

Aberrant internal carotid artery in the parapharyngeal space are usually asymptomatic. Aberrant position classically described as tortuous , kinked or coiled depending on the deviation from the vertical place. These anatomical variation can place the ICA in close proximity to the pharyngeal wall and subsequently cause narrowing of the pharyngeal area. Although mostly asymptomatic, they may presented with symptoms such as dysphagia, cough and rarely dysphonia. Here we present a case of 66 years old Japanese lady in East Coast of Malaysia with aberrant left ICA presented with dysphagia and a background history of alleged fish bone ingestion. Endoscopic examinations showed pulsatile mass over left posterior pharyngeal wall. Radiological examination was done to confirmed the diagnosis, Computed Tomography (CT) neck showed abnormal orientation of left ICA. Aberrant ICA is rarely reported as it is mostly asymptomatic, but it may lead to potentially life threatening event such as iatrogenic bleeding from the aberrant ICA during procedure. Thorough examinations in diagnosing this kind of patient is necessary especially when patient came in with vague symptoms and history