Kinked Carotids

An 80-year-old woman presented with congestive heart failure due to aortic insufficiency associated with a markedly dilated ascending aorta. On physical examination, she was noted to have a pulsatile mass in her neck that she reported had been present for more than a decade (Panel A). A three-dimensional reconstruction obtained from data from a computed tomographic angiogram (Panel B, and Figure 1 in the Supplementary Appendix [available with the full text of this article at NEJM.org]) revealed bilaterally kinked common carotid arteries. Kinks — or acutely angled bends — in carotid arteries can be seen in up to 5% of . . .