An Aberrant Internal Carotid Artery Mimicking a Pharyngeal Mass: A Rare Cause of Dysphagia.

Aberrant course of the internal carotid artery (ICA) within the pharyngeal wall is an uncommon vascular anomaly that can present with symptoms mimicking structural or neoplastic lesions. Recognition of this variation is critical to avoid catastrophic complications during diagnostic or therapeutic interventions. Case Presentation: An 89-year-old woman presented with a one-year history of gradually progressive, painless, and persistent dysphagia. Clinical examination was unremarkable. Flexible laryngoscopy revealed a bulge in the left lateral pharyngeal wall just above the level of the vocal cords with pooling of secretions in the vallecula and the left pyriform sinus. Contrast-enhanced computed tomography (CECT) of the neck demonstrated an aberrant ICA causing the submucosal protrusion. Given the high risk of hemorrhage, surgical intervention was deferred. The patient was managed conservatively with counseling and ergotherapy focused on swallowing rehabilitation. This case underscores the importance of considering rare vascular anomalies, including aberrant ICA, in the differential diagnosis of dysphagia. Preoperative imaging evaluation is crucial before attempting any invasive procedure in the pharyngeal region to prevent potentially fatal vascular injury.