1
|
Xu L, Kang Y, Wen X. A Case Report of a Bilateral Carotid Body Tumor and a Review of Its Imaging Manifestations. J Belg Soc Radiol 2023; 107:23. [PMID: 37034108 PMCID: PMC10077979 DOI: 10.5334/jbsr.2952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/23/2023] [Indexed: 04/11/2023] Open
Abstract
Bilateral carotid body tumors (CBTs) are extremely uncommon. In recent years, some clinical cases have been documented. A case of bilateral CBT is reported with a review of its imaging manifestations. When a unilateral CBT is discovered, assessment of the contralateral site is essential. The 'goblet' sign is a characteristic imaging feature of CBT. The preferred imaging modality is computed tomography angiography. Teaching Point When a carotid body tumor is suspected on one side, careful examinationof the contralateral side is essential; The preferred imaging approach is CTA.
Collapse
Affiliation(s)
- Long Xu
- Ziyang People’s Hospital, CN
| | | | | |
Collapse
|
2
|
Lollert A, Miederer M, Russo A, Staatz G. [Pheochromocytoma and paraganglioma during childhood and adolescence]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:1043-1049. [PMID: 35948798 DOI: 10.1007/s00117-022-01048-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pheochromocytoma and paraganglioma belong to the group of rare catecholamine-producing tumours during childhood and adolescence. They occur most frequently in patients with tumour predisposition syndromes. Imaging is essential to assess tumour stage and to plan therapy initiation. OBJECTIVE The aim of this review is a summary of the most important characteristics of the aforementioned tumour entities with a special focus on imaging. In particular, magnetic resonance imaging (MRI) as well as nuclear medicine techniques are presented. MATERIALS AND METHODS Diagnostic methods in patients with pheochromocytoma and paraganglioma are presented based on the literature and own case reports. RESULTS The radiologic modality of choice for the staging of catecholamine-producing tumours during childhood and adolescence is MRI, due to the lack of ionizing radiation and high soft tissue contrast. In addition, 123-I-meta-iodo-benzyl-guanidine (MIBG) scintigraphy and positron emission tomography/computer tomography (PET/CT) are performed. Whole-body MRI is particularly important as a screening tool in patients with a tumour predisposition syndrome. CONCLUSIONS Radiologic imaging and nuclear medicine techniques are important for the assessment of disease stage and therapy planning in patients with catecholamine-producing tumours. Detection of metastatic disease is essential, as there are no known histopathologic markers, which can predict the metastatic potential of the tumours.
Collapse
Affiliation(s)
- André Lollert
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Sektion Kinderradiologie, Universitätsmedizin der Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - Matthias Miederer
- Klinik und Poliklinik für Nuklearmedizin, Universitätsmedizin der Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Alexandra Russo
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin der Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Gundula Staatz
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Sektion Kinderradiologie, Universitätsmedizin der Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland
| |
Collapse
|
3
|
Gu G, Zhang X, Shen J, Gulidanna S, Gao Q, Shao J, Liu B, Zhang B, Zheng Y. Comparison of Contrast-Enhanced Ultrasonography to Color Doppler Ultrasound in Evaluation of Carotid Body Tumors. Front Oncol 2022; 12:872890. [PMID: 35480104 PMCID: PMC9035876 DOI: 10.3389/fonc.2022.872890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The objectives of this study were to prospectively 1) explore the characteristics and enhanced patterns of carotid body tumors (CBTs) at color Doppler ultrasound (CDU) and contrast-enhanced ultrasonography (CEUS) qualitatively and quantitatively and 2) compare CDU and CEUS for their morphology and vascularity signature. Methods CDU and CEUS with Sonovue® were used to evaluate 25 CBT lesions. The comparison between these ultrasonic modalities included the size, Shamblin type, vascularity, and feeding vessels of the lesion areas. The time–intensity curve (TIC) analysis was used to obtain the dynamics of the contrast-enhancement features of CBTs. Results The TIC analysis presented a fast wash-in [wash-in time: 3.00 ± 1.10 s, mean ± SD] and slow wash-out [wash-out time: 58.79 ± 24.21 s, mean ± SD] pattern in the CBT lesions, with a high area under the curve (AUC) of 669.68 ± 143.46 mm2 (mean ± SD). In comparison with CDU, CEUS was superior in identifying Shamblin type I or III CBT lesions (χ2 = 17.389, p=0.002). It detected a significant difference in the AUC between moderate and marked vascularity groups (563.33 ± 102.63 vs. 707.22 ± 138.81, t=-2.311, p=0.031.), while CDU observed no significant difference between these two groups. Although CDU was more sensitive than CEUS in detecting feeding vessels (100% vs. 88%), CEUS better visualized the origins of feeding vessels (χ2 = 9.162, p=0.010). Conclusion CEUS can better investigate the Shamblin type and vascularity of CBT lesions than CDU. CBTs displayed a fast wash-in, slow wash-out pattern with high AUC in the TIC analysis in the CEUS mode. CDU is more sensitive in detecting feeding vessels than CEUS, while CEUS can better visualize the origins of feeding vessels.
Collapse
Affiliation(s)
- Guangchao Gu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xiaoyan Zhang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Beijing, China
| | - Junyue Shen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shayan Gulidanna
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Qiong Gao
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Bo Zhang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Beijing, China
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
- *Correspondence: Yuehong Zheng, ; Bo Zhang,
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Yuehong Zheng, ; Bo Zhang,
| |
Collapse
|
4
|
Liu J, Mu H, Zhang W. Diagnosis and treatment of carotid body tumors. Am J Transl Res 2021; 13:14121-14132. [PMID: 35035757 PMCID: PMC8748146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/27/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To investigate the clinical diagnosis, treatment, and complication prevention of carotid body tumors (CBTs). METHODS The medical records of 24 patients with CBTs treated in the Department of Oral and Maxillofacial Surgery in Shandong Provincial Hospital Affiliated to Shandong First Medical University from 1999 to 2014 were reviewed. All the patients had unilateral CBTs and underwent preoperative B-mode ultrasound. Before surgery, CBT diagnosis was confirmed by digital subtraction angiography (DSA) in 8 patients, magnetic resonance imaging (MRI) in 9 patients, and computed tomography angiography (CTA) in 11 patients. All the patients had surgical intervention and preoperative Matas test. The retrograde stump pressure in the internal carotid artery was monitored in all the cases during surgery. Transcranial Doppler (TCD) inspection was performed on all patients before and during surgery. Simple tumor resection was performed in 8 patients, and excision of both the tumor and external carotid artery was performed in 11 cases. Five patients received intraluminal shunt after tumor resection and partial removal of internal, external, and common carotid arteries. RESULTS The diagnostic accuracy of B-mode ultrasound, DSA, MRI, and CTA was 75%, 100%, 88.9%, and 90.9%, respectively. In the enrolled 24 patients, tumors were completely removed with no postoperative death, hemiplegia, or blindness. There were 4 cases of transient hypoglossal nerve palsy and 1 case of transient vagus nerve involvement after surgery, which were recovered after 4-8 months of follow-up. No recurrence was found in the included patients during the followed-up, varied from 3 months to 4 years. B-mode ultrasound examination can be used as a preliminary screening method. DSA, CTA, and MRI are all effective diagnostic tools for CBTs. Among them, the diagnostic coincidence rate of DSA is 100%, making it the most effective means of inspection. Surgical resection is the first choice for the treatment of CBT patients who are willing to undergo surgery. CONCLUSIONS Preoperative routine Matas test can improve the brain tolerance of patients with carotid artery occlusion, preoperative, and intraoperative TCD monitoring are beneficial to understand the intracranial circulation in the circle of Willis. Intraoperative monitoring of residual arterial pressure and intraluminal shunt can prevent or significantly reduce the incidence of serious postoperative complications.
Collapse
Affiliation(s)
- Junjie Liu
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021, Shandong, China
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong UniversityJinan 250021, Shandong, China
| | - Hong Mu
- Department of Otorhinolaryngology, Qi Lu Children’s Hospital of Shandong UniversityJinan 250022, Shandong, China
| | - Weidong Zhang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021, Shandong, China
| |
Collapse
|
5
|
Montes D, Romero JM. Imaging of nonatheromatous carotid artery disease. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2021. [DOI: 10.1177/2514183x211014511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Imaging diagnosis of nonatheromatous carotid artery disease is challenging due to its low prevalence in contrast to that of atheromatous disease. Congenital anomalies are frequently discovered incidentally, as the chronicity of these conditions allows for compensatory flow development. The inflammatory conditions typically present with nonspecific courses, and a high clinical suspicion along with timely imaging evaluation can guide the diagnosis. Carotid dissection is the result of a partial disruption of the arterial wall and can be seen in previously healthy patients, in patients with underlying noninflammatory arteriopathies or trauma. Traumatic injuries to the carotid artery may occur under many different conditions and mechanisms and timely recognition of high-risk patients improves patient outcomes. Although free-floating thrombi (FFT) formation is typically seen with atherosclerotic plaque rupture, different conditions may also predispose to FFT. In this review article, we study the different imaging features of nonatheromatous carotid artery disease using ultrasonography, computed tomography angiography, magnetic resonance angiography, and digital subtraction angiogram.
Collapse
Affiliation(s)
- Daniel Montes
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Javier M Romero
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
6
|
Wiles AB. Additional ultrasound radiologic considerations for the cytopathologist with respect to thyroid paragangliomas. Cancer Cytopathol 2020; 129:417-418. [PMID: 33232575 DOI: 10.1002/cncy.22389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Austin B Wiles
- Department of Pathology, Virginia Commonwealth University Health System, Richmond, Virginia
| |
Collapse
|
7
|
Schwarze V, Marschner C, Negrao De Figueiredo G, Ingrisch M, Rübenthaler J, Clevert DA. Single-center study: dynamic contrast-enhanced ultrasound in the diagnostic assessment of carotid body tumors. Quant Imaging Med Surg 2020; 10:1739-1747. [PMID: 32879853 DOI: 10.21037/qims-19-920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Carotid body tumors (CBTs) depict the most common paraganglioma of the head and neck that can metastasize in up to 15% of cases. They develop either sporadically or hereditarily and may produce catecholamines ("functioning CBTs") resulting in associated symptoms like headache, palpitations or flush. Non-functioning CBTs usually present as slowly and often tender growing mass which may affect adjacent cranial nerves. CBTs can be visualized by ultrasound, CT, MRI or angiography. Pre-surgical interventional embolization, surgical resection and radiation therapy are therapeutical options. The aim of this retrospective single-center study is to assess the safe and real-time evaluation of CBTs by contrast-enhanced ultrasound (CEUS). Methods Ten patients with CBT were included in this study on whom CEUS was performed between 2007-2018 (mean age: 62 years). In 6/10 patients, results were confirmed by MRI, 4/12 patients underwent subsequent angiography. CEUS was performed and interpreted by a single consultant radiologist with experience since 2000 (EFSUMB level 3). VueBox® software was used for standardized perfusion quantification. Results CEUS allowed to detect all CBTs and visualize intratumoral microcirculation. Perfusion quantification was performed in 6/10 cases. CBTs showed significantly reduced peak-enhancement (PE), reduced wash-in perfusion index (WiPI) and significantly elevated time to peak (TTP) compared to common carotid arteries (CCA). Conclusions CEUS is a useful and safe tool for identifying CBTs and evaluating intratumoral microperfusion at high spatial and temporal resolutions in real-time. In addition to conventional ultrasound, CT, MRI and digital substraction angiography (DSA), CEUS may be implemented in the future diagnostic work-up and follow-up of CBT patients.
Collapse
Affiliation(s)
- Vincent Schwarze
- Department of Radiology, University Hospital, LMU Munich-Grosshadern Campus, Munich, Germany
| | - Constantin Marschner
- Department of Radiology, University Hospital, LMU Munich-Grosshadern Campus, Munich, Germany
| | | | - Michael Ingrisch
- Department of Radiology, University Hospital, LMU Munich-Grosshadern Campus, Munich, Germany
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital, LMU Munich-Grosshadern Campus, Munich, Germany
| | - Dirk-André Clevert
- Department of Radiology, University Hospital, LMU Munich-Grosshadern Campus, Munich, Germany
| |
Collapse
|
8
|
Chen HT, Cheng YY, Tsao TF, Peng CM, Hsu JD, Tyan YS. Abdominal Ultrasound in the Detection of an Incidental Paraganglioma. J Med Ultrasound 2020; 29:119-122. [PMID: 34377644 PMCID: PMC8330680 DOI: 10.4103/jmu.jmu_25_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/29/2020] [Accepted: 05/15/2020] [Indexed: 11/26/2022] Open
Abstract
Paraganglioma is a tumor that originates from neuroendocrine cells of the sympathetic or parasympathetic systems. Patients may suffer from headaches, palpitations, diaphoresis, and hypertension due to catecholamine excess or symptoms from the mass effect of the tumor. In the absence of typical symptoms of catecholamine excess, the diagnosis of a nonfunctional paraganglioma is often delayed. Herein, we report a case of a 63-year-old female patient with a nonfunctional paraganglioma which is an accidental finding during investigation of a fever. Abdominal ultrasonography incidentally detected this lesion as a complex, solid, cystic mass in the left suprarenal retroperitoneum.
Collapse
Affiliation(s)
- Hsiao-Ting Chen
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - Yung-Yin Cheng
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - Teng-Fu Tsao
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Ming Peng
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Division of General Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jeng-Dong Hsu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Pathology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| |
Collapse
|
9
|
Marchetti L, Perrucci L, D'Ercole F, Zatelli MC, Ambrosio MR, Giganti M, Carnevale A. Neck paraganglioma and follicular lymphoma: a case report. J Med Case Rep 2019; 13:376. [PMID: 31856921 PMCID: PMC6924013 DOI: 10.1186/s13256-019-2323-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/21/2019] [Indexed: 12/17/2022] Open
Abstract
Background Paragangliomas and pheochromocytomas are sympathetic or parasympathetic tumors derived from the paraganglia and the adrenal medulla, respectively. Paragangliomas and pheochromocytomas can be sporadic or familial, the latter frequently being multifocal and possibly due to succinate dehydrogenase complex genes mutations. In addition, 12% of sporadic paragangliomas are related to covered succinate dehydrogenase complex mutations. The importance of identifying succinate dehydrogenase complex mutations is related to the risk for these patients of developing multiple tumors, including non-endocrine ones, showing an aggressive clinical presentation. Case presentation We report the case of a 45-year-old Caucasian man with an indolent mass in his neck. Ultrasound of his neck, magnetic resonance imaging, and 1,4,7,10-tetraazacyclododecane-N(I),N(II),N(III),N(IIII)-tetraacetic acid(D)-Phe(1)-thy(3)-octreotide (68Ga-DOTATOC) positron emission tomography-computed tomography and endocrine work-up were consistent with a carotid body paraganglioma with concomitant nodal enlargement in several body regions, which turned out to be a follicular lymphoma at histology. He was found to carry a germline Succinate dehydrogenase subunit B gene (SDHB) mutation. Conclusion It is crucial to look for a second malignancy in the case of a paraganglioma demonstrating succinate dehydrogenase complex germline mutations.
Collapse
Affiliation(s)
- Lara Marchetti
- Department of Interventional and Diagnostic Radiology, Arcispedale Sant'Anna, Ferrara, Italy
| | - Luca Perrucci
- Section of Diagnostic Imaging, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy. .,University Radiology Unit, Radiology Department, Sant'Anna University Hospital, Ferrara, Italy.
| | - Francesca D'Ercole
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria Rosaria Ambrosio
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Melchiore Giganti
- Section of Diagnostic Imaging, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Aldo Carnevale
- University Radiology Unit, Radiology Department, Sant'Anna University Hospital, Ferrara, Italy
| |
Collapse
|
10
|
Szymańska A, Szymański M, Gołąbek W, Drelich-Zbroja A, Jargiełło T. Doppler ultrasound appearance of neck tumors. J Ultrason 2018; 18:96-102. [PMID: 30335917 PMCID: PMC6440510 DOI: 10.15557/jou.2018.0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 11/22/2022] Open
Abstract
Aim: The purpose of this study was the evaluation of the sonographic appearance of neck tumors and determining the features useful in differential diagnosis. Material and method: The studied group consisted of 57 patients: 16 patients with carotid body tumors, 9 patients with neurogenic tumors, 8 patients with venous anomalies, 12 patients with neck cysts, 6 patients with lipomas, 5 patients with extracranial carotid artery aneurysms and 1 with a laryngocele. Results: All carotid paragangliomas were located within the carotid bifurcation and demonstrated rich low-resistance vascular flow, with higher maximum velocity and lower flow resistance parameters registered in the ipsilateral external carotid artery. In 7 out of 9 cases, neurogenic tumors were homogeneous, and in the remaining 2 cases – heterogeneous. Four schwannomas were hypervascular or showed moderate vascularity, and the rest of neurogenic tumors were hypovascular or avascular, with symmetrical maximum velocity and resistance values of carotid blood flow. Apart from one branchial cleft cyst with multiple fine internal acoustic reflexes, all other neck cysts were anechoic and avascular, and presented with posterior acoustic enhancement. The laryngocele presented as a well-demarcated, hypoechoic, homogeneous lesion located in the immediate proximity of the larynx, without signs of internal vascular flow. Lipomas were well-demarcated, homogeneous, hypoechoic tumors with regular margins, without signs of internal vascular flow. Venous malformations presented as irregular, hypoechoic spaces with venous blood flow, easily compressed by the probe. Extracranial carotid artery aneurysms were hypoechoic, well-defined spaces, which presented with slow internal, turbulent flow on Doppler study, and showed continuity with the carotid artery. Conclusions: Doppler ultrasound allows to visualize features characteristic for certain neck tumors. Solid or cystic structure, echogenicity, localization, as well as internal flow signals and vascularity pattern create a combination of ultrasound findings helpful in the differential diagnosis of lesions such as paragangliomas, venous malformations, neurogenic tumors, aneurysms, cysts and laryngoceles.
Collapse
Affiliation(s)
- Anna Szymańska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Marcin Szymański
- Department of Otolaryngology and Head and Neck Surgery, Medical University of Lublin, Lublin, Poland
| | - Wiesław Gołąbek
- Professor Emeritus of Otolaryngology, Health Department, Pope John Paul II State School of Higher Education in Biała Podlaska, Biała Podlaska, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| |
Collapse
|
11
|
Sun Q, Xie C, Niu Z, Su L, Wang X, Fang Z, Zhao J, Chen S, Li X, Sun M. Diagnosis and treatment of a carotid body tumor: A case report of a rare bilateral tumor. Oncol Lett 2018; 14:6417-6420. [PMID: 29375704 PMCID: PMC5754906 DOI: 10.3892/ol.2017.7101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 04/27/2017] [Indexed: 11/05/2022] Open
Abstract
In the present case report, a rare bilateral carotid body tumor (CBT) and the imaging and pathological features of a CBT are described. In the present report, a rare case of bilateral carotid body tumor, which developed in the bifurcation of the common carotid artery, and the clinical manifestations, imaging and pathological features of this CBT are summarized. The imaging cannot validate the diagnosis; however, imaging identified that the tumor exhibited an intact envelope. Immunohistochemical staining revealed that the tumor cells were strongly positive for cluster of differentiation 56, Syn and protein S-100, moderately positive for transcription factor E3, negative for cytokeratin and epithelial membrane antigen, and partial cells were weakly positive for Desmir (<5%). In view of the clinical and pathological features of the carotid body tumor, surgery is hypothesized to be the optimal treatment and may enable the tumor to be resected completely. Refined surgical techniques provide the security of safe resection and decrease the risk of complications occurring.
Collapse
Affiliation(s)
- Qiang Sun
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Chenlu Xie
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Zhixing Niu
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Lei Su
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Xi Wang
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Zheng Fang
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Junfang Zhao
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Shuai Chen
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Xinming Li
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Minglei Sun
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| |
Collapse
|
12
|
Bhatt S, Verma P, Meena N, Tandon A, Tanveer N, Bansal D. Glomus vagale tumour, can it be diagnosed only on sonography? J Ultrasound 2017; 20:73-79. [PMID: 28298947 DOI: 10.1007/s40477-016-0237-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/25/2016] [Indexed: 10/20/2022] Open
Abstract
Vagal paragangliomas are rare benign tumors accounting for only 3% of head and neck paragangliomas and arise from vagal ganglions, predominately the nodose ganglion in the carotid sheath. Imaging plays an important role in their diagnosis, differentiation from more common lesions presenting in the carotid space, and management. MRI is the method of choice for investigation when paragangliomas are clinically suspected. The typical salt-and-pepper appearance in T1-weighted images is well known but not specific to paragangliomas. Demonstration of the continuity of the lesion with the vagus nerve on magnetic resonance imaging (MRI) further asserts the diagnosis of glomus vagale. Although this tumor can be diagnosed on a contrast-enhanced computed tomography (CECT) examination, it is limited by the non-demonstration of its neural origin. Sonography is considered only a preliminary investigation in patients, and a CECT and/or MRI study of the neck is conducted before treatment planning. This case is unique as a confident diagnosis of glomus vagale was made on high-resolution sonography of the neck. A middle-aged male patient presenting with a neck swelling was diagnosed with a glomus vagale tumor on USG by the direct demonstration of its continuity with the vagus nerve, and Doppler examination confirmed its vascularity. The diagnosis was confirmed on histopathology after surgical excision. The sonographic appearance, Doppler characteristics, and imaging differential diagnosis of glomus vagale are discussed in detail.
Collapse
Affiliation(s)
- Shuchi Bhatt
- Department of Radio-diagnosis, University College of Medical sciences (University of Delhi) and GTB Hospital, Dilshad Garden, Delhi, 110095 India
| | - Pooja Verma
- Department of Radio-diagnosis, University College of Medical sciences (University of Delhi) and GTB Hospital, Dilshad Garden, Delhi, 110095 India
| | - Neha Meena
- Department of Radio-diagnosis, University College of Medical sciences (University of Delhi) and GTB Hospital, Dilshad Garden, Delhi, 110095 India
| | - Anupama Tandon
- Department of Radio-diagnosis, University College of Medical sciences (University of Delhi) and GTB Hospital, Dilshad Garden, Delhi, 110095 India
| | - Nadeem Tanveer
- Department of Pathology, University College of Medical Sciences (University of Delhi) and GTB Hospital, Dilshad Garden, Delhi, 110095 India
| | - Divya Bansal
- Department of Pathology, University College of Medical Sciences (University of Delhi) and GTB Hospital, Dilshad Garden, Delhi, 110095 India
| |
Collapse
|
13
|
Dixon JL, Atkins MD, Bohannon WT, Buckley CJ, Lairmore TC. Surgical management of carotid body tumors: a 15-year single institution experience employing an interdisciplinary approach. Proc AMIA Symp 2016; 29:16-20. [PMID: 26722157 PMCID: PMC4677842 DOI: 10.1080/08998280.2016.11929343] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Cervical paragangliomas are rare neoplasms that arise from extraadrenal paraganglia in close association with the cranial nerves and extracranial arterial system of the head and neck, and therefore surgical extirpation can be challenging. A retrospective study was conducted of all patients undergoing surgical excision of a cervical paraganglioma between 2000 and 2015. The demographic characteristics, clinical features, surgical approach, and outcomes were reviewed. A total of 20 cervical paragangliomas were excised in 17 patients. There were 14 female and 3 male patients with a mean age of 56.6 ± 17.0 at the time of operation. Twelve patients had unilateral tumors and 5 patients had bilateral tumors. Familial involvement was confirmed by history or direct genetic analysis in 8 (47%) of the 17 patients. There were no malignant paragangliomas, and only 3 patients had tumors that were determined to be functional. Tumor size ranged from 1.3 to 6.0 cm. Two patients required combined arterial resection as part of complete excision of the tumor. There were no permanent operative cranial nerve injuries, no recurrences, minimal morbidity, and no mortality. In conclusion, optimal management of cervical paragangliomas should include a thorough preoperative evaluation, accurate definition of the surgical anatomy, and exclusion of synchronous paragangliomas. A combined therapeutic approach by a multidisciplinary team including surgeons and interventional radiologists provides safe and effective management of cervical paragangliomas with very low morbidity and excellent outcomes.
Collapse
Affiliation(s)
- Jennifer L Dixon
- Baylor Scott & White Healthcare and Texas A&M University Health Science Center College of Medicine, Temple, Texas
| | - Marvin D Atkins
- Baylor Scott & White Healthcare and Texas A&M University Health Science Center College of Medicine, Temple, Texas
| | - William T Bohannon
- Baylor Scott & White Healthcare and Texas A&M University Health Science Center College of Medicine, Temple, Texas
| | - Clifford J Buckley
- Baylor Scott & White Healthcare and Texas A&M University Health Science Center College of Medicine, Temple, Texas
| | - Terry C Lairmore
- Baylor Scott & White Healthcare and Texas A&M University Health Science Center College of Medicine, Temple, Texas
| |
Collapse
|
14
|
Paschoal FM, Albuquerque Paschoal EH, Rogério RM, Teixeira MJ, Bor-Seng-Shu E. Neck paraganglioma: head rotation maneuver on transcranial Doppler ultrasonography. Clin Neurol Neurosurg 2015; 137:5-7. [PMID: 26115050 DOI: 10.1016/j.clineuro.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/04/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Fernando Mendes Paschoal
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, Sao Paulo University Medical School, Brazil.
| | - Eric Homero Albuquerque Paschoal
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, Sao Paulo University Medical School, Brazil
| | | | - Manoel Jacobsen Teixeira
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, Sao Paulo University Medical School, Brazil
| | - Edson Bor-Seng-Shu
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, Sao Paulo University Medical School, Brazil
| |
Collapse
|
15
|
|
16
|
Casarim ALM, Tincani AJ, Negro AD, Aguiar CG, Fanni RV, Martins AS. Carotid body tumor: retrospective analysis on 22 patients. SAO PAULO MED J 2014; 132:133-9. [PMID: 24760216 PMCID: PMC10852084 DOI: 10.1590/1516-3180.2014.1323452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 06/27/2013] [Accepted: 07/16/2013] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Carotid body tumors, or chemodectomas, are the most common head and neck paragangliomas, accounting for 80% of the cases. They may present minor symptoms; however, they deserve special attention in order to achieve accurate diagnosis and adequate treatment. The objectives of this study were to show the approach towards chemodectomas and evaluate the complications of the patients treated surgically without previous embolization. DESIGN AND SETTING Retrospective study on chemodectomas followed up at the Head and Neck Surgery Service, Department of Surgery, Unicamp. METHODS Twenty-two patients were evaluated between 1983 and 2009. The diagnosis was based on clinical findings and imaging methods. The epidemiological characteristics, lesion characteristics, diagnostic methods, treatment and complications were analyzed. RESULTS The paragangliomas were classified as Shamblin I (9%), II (68.1%) and III (22.7%). Angiography, magnetic resonance imaging and computed tomography confirmed the diagnosis in 20 patients (90.9%). Five (22.7%) had significant bleeding during the surgery, while four (18.1%) had minor bleeding. Four patients (18.1%) developed neurological sequelae. Seven (31.8%) needed ligatures of the external carotid artery. Three patients (13.6%) underwent carotid bulb resection. The postoperative follow-up ranged from 3 months to 14 years without recurrences or mortality. CONCLUSIONS In our experience and in accordance with the literature, significant bleeding and neurological sequelae may occur in chemodectoma cases, particularly in Shamblin III patients. The complications from treatment without previous embolization were similar to data in the literature data, from cases in which this procedure was applied prior to surgery.
Collapse
Affiliation(s)
- André Luís Maion Casarim
- MD. Attending Physician, Head and Neck Surgery Service, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Alfio José Tincani
- MD, PhD. Associate Professor, Head and Neck Surgery Service, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - André Del Negro
- MD, PhD. Associate Professor, Head and Neck Surgery Service, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Camila Guimarães Aguiar
- MD. Attending Physician, Head and Neck Surgery Service, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Renato Ventura Fanni
- MD. Attending Physician, Head and Neck Surgery Service, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Antonio Santos Martins
- MD, PhD. Associate Professor, Head and Neck Surgery Service, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
| |
Collapse
|