1525: Case Study: Upper Neck Mass - A Carotid Body Tumour or Not?

Abstract

ObjectiveTo determine whether Carotid Duplex Ultrasound (CDU) allows definitive differentiation of Carotid Body Tumour (CBT) from other masses.CDU has historically been used in diagnosing patients presenting with an upper neck mass. Diagnosis would be made on CDU features (anatomic location of the mass, splaying of the carotid bifurcation with a colour blush enhancing a subtle mass) to differentiate CBT from other masses.MethodsA 53 year old female presented with history of headaches and episodes of feeling faint. She was unaware of neck swelling until other investigations disclosed this. CDU was performed to assess extracranial carotid circulation for presence of possible disease, haemodynamically significant lesions etc. The nature and relation of the neck mass to the carotid vessels was established.ResultsCDU demonstrated anatomic location of the mass, splaying of the right carotid bifurcation with a colour blush enhancing a subtle mass. Findings were consistent with a diagnosis of CBT. CT findings demonstrated glomus vagale tumour with differential diagnoses including schwannoma of the carotid space or carotid body paraganglioma. Angiography demonstrated right glomus jugulare tumour supplied by ascending pharyngeal & occipital arteries. Diagnosis was confirmed with operative findings and histology results.ConclusionCDU is a useful tool in distinguishing CBT from other upper neck masses, but this case illustrates that CDU features alone cannot adequately and universally differentiate between CBT & other paragangliomas, such as glomus vagale tumours. We recommend reporting of these lesions should suggest initial diagnosis of paraganglioma, not CBT, pending further diagnostic studies. ObjectiveTo determine whether Carotid Duplex Ultrasound (CDU) allows definitive differentiation of Carotid Body Tumour (CBT) from other masses.CDU has historically been used in diagnosing patients presenting with an upper neck mass. Diagnosis would be made on CDU features (anatomic location of the mass, splaying of the carotid bifurcation with a colour blush enhancing a subtle mass) to differentiate CBT from other masses. To determine whether Carotid Duplex Ultrasound (CDU) allows definitive differentiation of Carotid Body Tumour (CBT) from other masses. CDU has historically been used in diagnosing patients presenting with an upper neck mass. Diagnosis would be made on CDU features (anatomic location of the mass, splaying of the carotid bifurcation with a colour blush enhancing a subtle mass) to differentiate CBT from other masses. MethodsA 53 year old female presented with history of headaches and episodes of feeling faint. She was unaware of neck swelling until other investigations disclosed this. CDU was performed to assess extracranial carotid circulation for presence of possible disease, haemodynamically significant lesions etc. The nature and relation of the neck mass to the carotid vessels was established. A 53 year old female presented with history of headaches and episodes of feeling faint. She was unaware of neck swelling until other investigations disclosed this. CDU was performed to assess extracranial carotid circulation for presence of possible disease, haemodynamically significant lesions etc. The nature and relation of the neck mass to the carotid vessels was established. ResultsCDU demonstrated anatomic location of the mass, splaying of the right carotid bifurcation with a colour blush enhancing a subtle mass. Findings were consistent with a diagnosis of CBT. CT findings demonstrated glomus vagale tumour with differential diagnoses including schwannoma of the carotid space or carotid body paraganglioma. Angiography demonstrated right glomus jugulare tumour supplied by ascending pharyngeal & occipital arteries. Diagnosis was confirmed with operative findings and histology results. CDU demonstrated anatomic location of the mass, splaying of the right carotid bifurcation with a colour blush enhancing a subtle mass. Findings were consistent with a diagnosis of CBT. CT findings demonstrated glomus vagale tumour with differential diagnoses including schwannoma of the carotid space or carotid body paraganglioma. Angiography demonstrated right glomus jugulare tumour supplied by ascending pharyngeal & occipital arteries. Diagnosis was confirmed with operative findings and histology results. ConclusionCDU is a useful tool in distinguishing CBT from other upper neck masses, but this case illustrates that CDU features alone cannot adequately and universally differentiate between CBT & other paragangliomas, such as glomus vagale tumours. We recommend reporting of these lesions should suggest initial diagnosis of paraganglioma, not CBT, pending further diagnostic studies. CDU is a useful tool in distinguishing CBT from other upper neck masses, but this case illustrates that CDU features alone cannot adequately and universally differentiate between CBT & other paragangliomas, such as glomus vagale tumours. We recommend reporting of these lesions should suggest initial diagnosis of paraganglioma, not CBT, pending further diagnostic studies.