Presentation
Suspected vertebral artery dissection
Patient Data
There was no evident vertebral artery dissection.
As variant anatomy, the right ascending pharyngeal artery is seen originating from the internal carotid artery (ICA) immediately after its bifurcation from the common carotid artery (CCA), rather than its usual origin from the external carotid artery (ECA), as can be seen normally on the left.
Annotated images
On the right, there is an anomalous origin of the ascending pharyngeal artery from the internal carotid artery after it's bifurcation from the common carotid. Bilaterally, the ascending pharyngeal arteries can be seen coursing superiorly, between the posterolateral pharynx and the internal carotids. On the sagittal oblique multiplanar reconstruction (MPR) images, the origin of the right occipital artery is seen and should not be confused with the ascending pharyngeal.
Case Discussion
Very rarely, the ascending pharyngeal artery can arise from the ICA, either as an isolated variant or as part of more complex variant anatomy 1,2,3. It is important to recognise and mention this variant, especially if carotid surgery is being planned.