External carotid-external jugular arteriovenous fistula

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Right parotid pulsatile mass since birth with decreased hearing.

Evidence of arteriovenous fistulous communication between the distal branches of the right external carotid artery and tributaries of the right external jugular vein and right retromandibular vein with aneurysmal dilatation of the right external carotid artery as well as right external jugular vein within the right parotid gland with dilated tortuous veins are noted within the deep spaces of the neck namely the right masticator, buccal as well as parapharyngeal, parotid, carotid spaces and posterior triangle.  Dilated tributaries of the external jugular vein namely the posterior external jugular, anterior jugular and suprascapular as well as transverse cervical veins are noted. Mild dilatation of the right common carotid artery as well as the proximal few centimeters of the right internal carotid artery which appears otherwise intact with no aneurysmal dilatation, occlusion or significant stenosis.  Normal left common carotid, internal and external carotid arteries with no occlusion or significant stenotic lesions.

Normal appearance of the intracranial parts of both internal carotid arteries on either as well as anterior cerebral and middle cerebral arteries with no evidence of dissection or occlusions.

Normal appearance of the basilar and vertebral arteries.

No otherwise evidence of cerebral aneurysms or arteriovenous malformations.

Case Discussion

Congenital right external carotid artery-external jugular vein arteriovenous fistula with aneurysmal dilatation as well as dilated tributaries. 

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