Abstract
Patients: The subject was an 81-year-old man who died of cirrhosis. The left common carotid artery showed a severe tortuosity toward the left lateral side at the height of the fifth to sixth cervical vertebrae. Tortuosity of the vagus nerve and the sympathetic trunk were also noted. These findings suggested that the stellate ganglion block （SGB） procedure might have been difficult to perform. No abnormalities on the right side were noted.
Discussion: In this case, it was difficult to confirm pulsation of the common carotid artery in the normal position through palpation of the sternocleidomastoid muscle. Local anesthetic toxicity due to erroneous intravascular injection seemed to have occurred. Furthermore, although injecting a local anesthetic near the transverse process of the sixth cervical vertebra was possible despite the severe tortuosity of the sympathetic trunk, performing an SGB might not have been successful. The site of predilection of the tortuosity of the carotid artery suspected in this case is normally the right side, but it was observed on the left side, which is extremely rare. Although it is possible to visually recognize anatomical structures such as the common carotid artery with ultrasound guidance, knowledge of cervical anatomy is important.
Conclusion: In this case, tortuosity of the left common carotid artery that could result in a difficult SGB was observed in a cadaver used for anatomical training. When performing SGB, always consider the possibility of potential anatomical deviation and deformation, and if necessary, a careful attitude such as using an ultrasonic guide will lead to patient safety.
