Pulsating neck mass in a patient with transient ischaemic attack - an unusual case

The high-riding brachiocephalic trunk is a rare variation of the neck vessels that is often asymptomatic. It is usually discovered incidentally during neck surgeries and can sometimes result in life-threatening bleeding if not identified. Patients may have a pulsating mass in the front of the neck and may experience compressive symptoms such as difficulty in swallowing and stridor. We discuss a 71-year-old woman who presented with a pulsating anterior neck mass and also experienced a transient ischaemic attack. A computed tomography angiography of the neck vessels revealed normal carotid arteries and a high-riding variant of the brachiocephalic trunk along with atheromatous plaques. There were no signs of an aneurysm. Cerebrovascular accidents have been reported in patients with vascular anomalies of the neck vessels. However, the association of a high-riding variant of the brachiocephalic trunk with cerebrovascular accidents has not been discussed in current literature.