Caution: Carotid Artery Aneurysm May Disguise as Neck Tumor

Abstract

Objective: 1) To present a case where a right common carotid aneurysm was clinically undistinguishable from tumor. 2) Stress the importance of contrast-enhanced imaging in the workup of a neck mass. 3) Review of literature. Method: A 64-year-old male smoker with hypertension presented with hoarseness, dysphagia, and an enlarging right neck mass. Physical examination revealed 6-cm neck mass, nonfluctuant, nonpulsatile. F/L: Right parapharyngeal mass impinging right hemilarynx, causing partial airway obstruction. Noncontrast computed tomography (CT) scan was suggestive of neoplasia versus abscess formation. Contrast-enhanced CT revealed an aneurysm of the right carotid bifurcation. PubMed literature was reviewed. Results: Extracranial carotid aneurysms are rare (1-4%), with atherosclerosis being the most common etiology. They arise in the internal carotid (67%), bifurcation (32%), and the external carotid artery (1%). Airway obstruction and dysphagia has been reported in very few cases. In our patient this led to the clinical diagnosis of tumor. Contrast-enhanced imaging is essential in the workup of a neck mass. Management options include interposition bypass grafting, resection with patch angioplasty, or carotid ligation, as well as endovascular interventions with stenting or occlusion. Conclusion: Large carotid artery aneurysms may resemble a tumor and they must be considered in the differential diagnosis of a neck mass. The importance of contrast-enhanced imaging before attempting invasive procedures cannot be overemphasized.