Preoperative Evaluation of Paragangliomas of the Neck with Duplex Ultrasonography

Abstract

Objective

Paragangliomas in the neck are infrequent tumors that most frequently require surgical resection. Their diagnosis is possible with duplex ultrasonography, which can also assist in suggesting the usefulness of preoperative endovascular embolization.

Case Report

A 53-year-old woman was seen with a mildly symptomatic left neck mass. An extracranial cerebrovascular duplex ultrasound examination revealed a mass near the carotid bifurcation. It seemed to be splaying the internal and external carotid arteries and was highly vascularized with multiple small feeding vessels. This suggested a carotid body paraganglioma. An MRI, CT scan, and angiogram were supportive of a diagnosis of a carotid body tumor. Because of its rich vascularity, preoperative embolization was performed. The patient was subsequently taken to surgery, and the mass was successfully excised. Pathologic microscopic examination confirmed a carotid body paraganglioma.

Conclusion

The diagnosis of a carotid body paraganglioma is possible with duplex ultrasonography. The size of the tumor and the finding of multiple small vessels feeding the tumor can assist in suggesting the usefulness of preoperative embolization to reduce operative blood loss.