History: 50 year-old man with pulsatile right neck mass
Findings: An axial CT image demonstrates an intensely enhancing right carotid space mass that splays the internal and external carotid arteries. A lateral view of a right carotid arteriogram shows the intensely enhancing carotid bifurcation mass separating the internal and external carotid arteries.
Diagnosis: Carotid body paraganglioma
carotid body tumors are the most common extracranial head and neck paraganglioma. They arise from the carotid body, which is derived from neural crest tissue of the autonomic nervous system. Carotid body tumors typically splay the internal and external carotid arteries because they arise from tissue located at the carotid artery bifurcation. Thes tumors dramatically enhance on CT or MRI scans and demonstrate a persistent and intense vascular blush at arteriography. The combination of intense enhancement and flow voids on MRI has often been described as ‘salt and pepper’ appearance. Carotid body tumors are typically nonfunctional and are treated surgically, often after preoperative embolization. These tumors may be familial of multicentric in 10% of cases. One unusual fact is that they are much more common in people living at high altitudes than at sea level.
Aunt Minnie’s Pearls
- Carotid body tumors occur in the carotid space and splay te internal and external carotid arteries.
- These tumors enhance intensely and cause a ‘salt and pepper’ appearance on MRI.