Left carotid body paraganglioma

Case contributed by Maxime St-Amant


Suspicion of a left cervical mass.

Patient Data

Age: 75 years
Gender: Male

MRI shows a round lesion located between the internal and external carotid bifurcation, iso-intense to muscle on T1 & T2 (salt & pepper appearance), and enhancing avidly after gadolinium administration. The internal and external carotid arteries are splayed by the lesion.

The most probable diagnosis is a carotid body paraganglioma (carotid glomus tumor / chemodectoma)

MRI TOF revealed the enhancing left carotid bifurcation lesion, splaying each of carotid artery branches.

Case Discussion

The differential diagnosis is quite limited in this case, as there is a classic salt & pepper appearance of the lesion on T1 weighted images and splaying of the ICA / ECA. This is almost pathognomonic of carotid body paraganglioma.

The differential diagnosis for a tumor in this location includes :

  • vagal schwannoma: tends to displace both vessels together rather than splaying them
  • vagal neurofibroma: tends to displace both vessels together rather than splaying them
  • lymph node mass: may look similar if hypervascular
  • glomus vagale tumor: same pathology but located more rostrally
  • carotid bulb ectasia

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