Subclavian Artery Tortuosity Mimicking a Carotid Aneurysm: A Case Report

Pulsatile neck masses (PNMs) are relatively rare and require careful evaluation, as they have numerous potential differential diagnoses. A PNM may be of non-vascular or vascular origin, such as aneurysms and arterial tortuosities, which are anatomical variants. The distinction between these conditions should not be made solely based on physical examination. Arterial Doppler ultrasound is a useful method for the initial evaluation of PNM, allowing for the differentiation of aneurysms from vascular anatomical variants and thereby avoiding unnecessary interventions. We describe the case of an 83-year-old independent female patient with a history of hypertension, atrial fibrillation, and dyslipidemia. During a follow-up visit, the patient reported a seven-month history of a pulsatile mass in the right anteroinferior cervical region. She noted that the mass became more prominent with elevated blood pressure and denied any other associated symptoms. On physical examination of the cervical region, no murmurs were heard on bilateral carotid artery auscultation; a pulsatile mass was present in the right anteroinferior cervical region, measuring approximately 3.5 × 2.5 cm. No other relevant findings were noted. A carotid artery aneurysm was considered in the differential diagnosis. A carotid and vertebral Doppler ultrasound was requested, which revealed that the mass corresponded to moderate tortuosity of the right subclavian artery, a benign anatomical variant. No therapeutic intervention was necessary, and the patient remains under regular clinical follow-up. This case report demonstrates how a PNM caused by tortuosity of the right subclavian artery can be misinterpreted as a carotid artery aneurysm. Evaluation based solely on physical examination is insufficient, and arterial Doppler ultrasound is important for the initial assessment. The report underscores the importance of a thorough evaluation of PNMs and consideration of various differential diagnoses to avoid unnecessary procedures. This report contributes to the literature by highlighting that tortuosity of the right subclavian artery can present as a PNM and mimic a carotid artery aneurysm.