Aberrant carotid artery: recognition on high resolution computed tomography

In the investigation of a pulsatile retrotympanic mass it is important to recognize the high resolution computed tomography findings of an aberrant internal carotid artery. These include an absent exocranial opening of the carotid canal and a tubular density coursing along the medial wall of the middle ear in continuity with the horizontal carotid canal through a dehiscence of the lateral carotid plate. Our report highlights an unusual variation where two anomalous arteries, an aberrant internal carotid and an inferior tympanic to petrous carotid anastomoses, course through the middle ear.