Kissing carotid arteries: an unusual cause of prevertebral swelling.

To cite: Muhammad Gowdh NS, Gill FJ, Regan LA, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014206099 DESCRIPTION An 80-year-old woman with a history of recurrent falls presented to the emergency department following a fall. On examination she was found to be tender at the C4/5 level. A cervical spine radiograph revealed no fractures, however, there was significant prevertebral soft tissue swelling which measured up to 3 cm (figure 1A). An occult fracture was suspected and a CT of the cervical spine was requested. No fracture was identified; however, there was an unexpected finding of an aberrant course of the internal carotid arteries which accounted for the prevertebral soft tissue thickening (figure 1B). The internal carotid arteries were found to be tortuous, medially displaced and almost met in the midline, a variant colloquially known as ‘kissing carotids’ (figure 2). Anatomical variations of the extracranial internal carotid arteries occur in approximately 5% of the general population and are a cause of non-traumatic prevertebral soft tissue thickening.