Bilateral pulsating pharynx with abnormal internal carotid artery

A five years old female, presented with long standing snoring & recurrent tonsillitis. Examination showed pulsating soft palate & posterior pharyngeal wall. Magnetic resonance angiography (MRA) of the carotids revealed abnormal course of the right internal carotid artery (ICA) with its proximal segment coursing medially and reaching the midline of the retropharyngeal space. The right ICA kinked 2.3 cm medially. It was 3.1 mm posterior to the right palatine tonsil & 3.5 mm away from posterior part of the adenoid. The dilemma of undergoing adenotonsillectomy was considered to be of a high risk & the patient was kept on conservative management only.