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(Circulation. 2000;102:e173.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Congenital Kinking of the Internal Carotid Artery in Twin Brothers

Emmanuel Le Bret, MD; Emmanuelle Pineau, MD; Thierry Folliguet, MD; Eréa Noël Garabédian, MD; Francis Brunelle, MD; Pascal Vouhé, MD; François Laborde, MD

From the Institut Mutualiste Montsouris, Cardio-Vascular Department (E.L.B., E.P., T.F., P.V., F.L.), Armand Trousseau Children Hospital (E.N.G.), and Necker Sick Children Hospital (F.B.), Paris, France.

Correspondence to Emmanuel Le Bret, Institut Mutualiste Montsouris, Cardio-Vascular Department, 42 Boulevard Jourdan, 75014 Paris, France. E mail emmanuel.lebret@imm.fr

We report magnetic resonance (MR) angiographic evidence of congenital kinking of the internal carotid artery in 4-year-old twin brothers. The first twin presented with a left pulsating laterocervical mass 2 cm in diameter. On examination, the mass had a palpable thrill and a systolic murmur. An echo-Doppler examination showed a loop of the left internal carotid artery with no hemodynamic changes. MR angiography disclosed a left internal carotid artery loop with kinking just after the bifurcation. No arteriovenous fistula was noted (Figure 1.)

View larger version (146K): [in this window] [in a new window]   Figure 1. The first twin presented with a left carotid loop.

The second twin was completely asymptomatic. Clinical examination was normal, but an echo-Doppler examination revealed carotid loops on both sides, especially the right, with no hemodynamic changes. MR angiography showed kinking of the right internal carotid artery with a very acute internal angle close to the tonsil. The left carotid presented with an S-shaped tortuosity. No arteriovenous fistula was noted (Figure 2). We decided not to treat these patients surgically.

View larger version (159K): [in this window] [in a new window]   Figure 2. The second twin presented with carotid loops on both sides.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.