Patulous eustachian tubes and an unusual case of fused retropharangeal internal carotid arteries with an aberrant course through the clivus and dorsum sellae

Aberrant course of internal carotid arteries (ICA) is rarely seen. In patients who are asymptomatic, anomalies may be detected incidentally during head and neck examination. Symptomatic patients may present with hearing loss, pulsatile tinnitus, dysphagia or a foreign body sensation in the posterior pharynx. If the retropharyngeal course of ICA remains undiagnosed, accidental biopsy or surgical intervention can result in life threatening complications. The abnormal course of ICA results from a complex defect in embryological development and is unlikely to be an acquired process. Previously, bilateral and unilateral agenesis, hypoplastic, retropharyngeal tortuous ICA and kissing sellar ICA have been described in literature. We used various imaging techniques to describe this first case of fused ICA with an aberrant course through the clivus and dorsum sellae. The patient also presented with patulous Eustachian tubes on both the left and right side.