Carotid canal sympathetic schwannoma

Case contributed by Megan Ang

Presentation

Left retro-orbital headache associated with left eye watering and left nostril rhinorrhoea.

Patient Data

Age: 50 years
Gender: Male

Contrast enhanced CT shows a low density lesion within the left carotid canal which appears extrinsic to the ICA (located anterior and inferior to the vessel which is not narrowed). There is subtle expansion of the canal relative to the right, and smooth bone remodelling. 

MRI reveals a T2 hyperintense, T1 isointense, enhancing mass within the left carotid canal and extending partially into the left cavernous sinus. It extends a short distance into the neck below the carotid canal. 

Case Discussion

Although extremely rare, sympathetic schwannoma of the carotid canal is the likely diagnosis in this case. The signal characteristics and smooth bone remodelling are in keeping with schwannoma. Internal carotid artery dissection would be a far more common pathology to involve the carotid canal however the appearance in this case is clearly of an extrinsic mass and not dissection. 

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Case information

rID: 68925
Published: 18th Jul 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Excluded

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