Paraganglioma of the vagus nerve mimicking as a carotid body tumor

Abstract

A 58-year-old woman presented with a pulsatile swelling in the right neck of 12 years’ duration (A). The clinical examination revealed right ptosis, deviation of the tongue to right, and a large pulsatile swelling of 11 8 cm in the right neck lifting the right pinna. Cytologic evaluation of a fine needle aspiration specimen at another center showed blood. Computed tomography (CT) imagery demonstrated an intensely enhancing vascular mass lesion with extensive vascular arcades seen in the right parapharyngeal and submandibular region causing splaying of the carotid arteries, suggesting a carotid body tumor (Cover). On exploration, the tumor was arising from the vagus nerve, and this needed to be sacrificed for total excision of the tumor (B). The tumor was hypervascular, with multiple feeding vessels from the external carotid artery. Ligation of the external carotid artery resulted in reduced bleeding from the tumor and its separation from the internal carotid artery (C). Histopathologic examination suggested a vagal paraganglioma. Postoperatively, hoarseness developed and a nasogastric tube was placed for a week.