Presentation
Suspicion of a left cervical mass.
Patient Data
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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)
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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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