Bilateral Persistent Pharyngo-Stapedial Arteries Revealed during Evaluation of a Carotid-Cavernous Fistula

A 33-year-old caucasian woman was referred to the neuroradiologist for lower limbs angiography. The patient had a history of defenestration with polytraumatism two years earlier. The angiography was needed before rebuilding surgery of her left foot and turned out to be normal. Moreover, clinical examination by the neuroradiologist revealed a proptosis of the right eye with chemosis. Carotid angiography was performed and showed a right high-flow carotid-cavernous fistula, that drained into the inferior petrosal sinus, superior ophthalmic vein, Brechet sinus and cortical veins. The left carotid angiography incidentally revealed an anomalous vessel arising from the cervical part of the internal carotid artery and running superiorly through the middle ear to supply the middle meningeal artery. A diagnosis of left persistent pharyngostapedial artery was made, associated with an unusual emergence of the ascending pharyngeal artery from the internal carotid artery. A temporal bone CT showed the probable bilaterality of the anomaly, with bilateral absence of Summary