INTRODUCTION

Cystic medial necrosis is most commonly reported in patients with Marfan’s syndrome and aortic dissection.1 Cystic medial necrosis of the internal carotid artery leading to the formation of an isolated non-dissecting aneurysm is a rare clinical entity.2,3 We report a case that presented with an asymptomatic neck swelling.

CASE REPORT

A 59-year-old male patient presented with a 3-cm pulsatile right neck mass which had been present for 2 months (Figure1). It was not associated with pain or other symptoms. Apart from a history of hypertension for 20 years; his previous history was unremarkable. There was no history of neck injury. Marfanoid features were absent on physical examination. The diagnosis of carotid artery aneurysm was confirmed on duplex scan of the carotid arteries. Carotid angiogram revealed an aneurysm at the right internal carotid artery (Figure 2). Magnetic resonance angiogram showed a right internal carotid aneurysm measuring 3 x 4 x 4 cm,3 which contained mural thrombus within the aneurysmal wall.