Magnetic resonance angiography in neck masses

Splaying of the Carotid Bifurcation Caused by a Cervical Sympathetic Chain Schwannoma

Splaying of the carotid bifurcation revealed by an imaging study is usually indicative of a carotid body tumor, but there are other possibilities. To promote awareness of a cervical sympathetic chain schwannoma as another cause of splaying of the carotid bifurcation, we present a case of cervical sympathetic chain schwannoma, with an additional 7 cases in the English-language literature, and discuss the relationship between the great vessels of the neck and a carotid body tumor or a schwannoma of the cervical sympathetic chain or vagus nerve from an anatomic viewpoint. We conclude that splaying of the carotid bifurcation with hypervascularity suggests a carotid body tumor, whereas in cases without hypervascularity, a cervical sympathetic chain schwannoma is another possibility. Vagus nerve schwannomas can separate the internal jugular vein and internal carotid artery, but seldom widen the carotid bifurcation.

Infrahyoid neck

Imaging is an indispensable tool in patients with clinical suspicion of infrahyoid neck disease. CT and MR imaging can establish a positive diagnosis by showing a true mass (versus a pseudomass). In addition, by defining the exact space of origin of the lesion and its characteristics (CT density, MR signal, homo- or heterogeneity, contour, contrast enhancement), imaging can predict the correct diagnosis. Because it offers multiplanar, multiparameter information, MR imaging, performed with a dedicated coil and appropriate artifact-reduction techniques, usually is the modality of choice.