Hypervascular head and neck lesions

Hypervascular head and neck lesions are findings that enhance avidly after biphasic injection, on contrast-enhanced CT or MRI of the neck.

Anatomical variants

• ectopic thyroid gland
  • hyperdense soft tissue mass on non contrast-CT
  • intense homogeneous enhancement after contrast injection

Vascular malformations

• arteriovenous malformations (AVM)
• arteriovenous fistulae (AVF)

Neoplastic

• parathyroid adenoma
  • polar vessel sign
  • on non-contrast imaging, they are less dense than the thyroid parenchyma
  • hypercalcemia with elevated PTH
• paragangliomas of the head and neck
  • carotid body tumor ¹
    • most common paraganglioma of the head and neck
    • arise from the carotid body, and splays the carotid bifurcation
  • glomus tympanicum paraganglioma
    • second most common head and neck paraganglioma
    • arise from the glomus tympanicum
    • confined to the middle ear overlying the cochlear promontory
  • glomus jugulare paraganglioma
    • arise from the glomus jugulare
    • irregular and eroded bony margins with a moth-eaten pattern
    • erosion of the jugular spine
    • extends into the middle ear
  • glomus jugulotympanicum tumor
    • arise from the glomus jugulotympanicum
    • extends between the cochlear promontory and jugular foramen
• malignant peripheral nerve sheath tumors (MPNSTs)
• extracranial meningioma ⁴
• hypervascular metastatic lymphadenopathy
  • papillary thyroid carcinoma
  • neuroendocrine tumors
  • melanoma
• lymphadenopathy - lymphoproliferative disorders 
  • Castleman disease ²
  • Kimura disease ³
• epithelioid hemangioendothelioma