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

• vagal paraganglioma: same pathology but located more rostrally

• carotid bulb ectasia