Presentation
Right neck lump.
Patient Data
There is a relatively well-defined soft tissue mass lesion measured around three by two cm related to the right carotid bifurcation raising the possibility of carotid body tumor. A contrast-enhanced CT scan of the neck was advised.
The thyroid gland is normal in size, parenchymal echogenicity, and echotexture. No nodules or cysts are seen. No significant cervical adenopathy is seen. Unremarkable salivary glands.
There is a large well defined moderately enhancing mass lesion located in the right carotid bifurcation with splaying of the internal and external carotid arteries. It measures around 47 x 37 x 35 mm respectively in the maximal craniocaudal, anteroposterior and transverse dimensions.
The previously described mass is exerting mass effect narrowing the right internal jugular vein, medial bulging of the right side of the hypo and oropharynx, and mild effect upon the right submandibular gland which appears pushed anteriorly. CT findings are indicating carotid body tumor.
Few small deep and superficial cervical benign-looking lymph nodes are seen.
Paranasal sinus disease is noted with S-shaped nasal septal deviation and inferior turbinates hypertrophy.
Prominent palatine tonsils are noted.
Tiny calcification is seen in the right sublingual space measuring around 3 mm suggesting right submandibular duct stone.
Case Discussion
Initial evaluation of the neck, the lesion at the carotid bifurcation was thought lymph node. However, upon further scanning and interpreting, the lesion as centrally hypervascular. A carotid body tumor was suspected and further evaluation by CT was advised demonstrating splaying of the right internal and external carotid arteries, and enhancement after IV contrast administration suggesting a paraganglioma.
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