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Clinical Problem Solving
Radiology
November 2014

Growing Mass on the Right Side of the Neck

Author Affiliations
  • 1Department of Otolaryngology—Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York
  • 2Thyroid, Head, and Neck Cancer (THANC) Foundation, Mount Sinai Beth Israel, New York, New York
  • 3Department of Otolaryngology, Icahn School of Medicine, New York, New York
  • 4Department of Radiology, Mount Sinai Beth Israel, New York, New York
  • 5Department of Radiology, Albert Einstein College of Medicine, New York, New York
JAMA Otolaryngol Head Neck Surg. 2014;140(11):1085-1086. doi:10.1001/jamaoto.2014.2302

A man in his 70s presented with a 20-year history of a mass on the right side of his neck. On physical examination, he was found to have a large mass on the right side of his neck, approximately 6 cm in diameter. Initial computed tomographic (CT) examination identified a partially intensely enhancing and partially necrotic lesion at the right carotid bifurcation measuring 5.5 × 4.8 × 4.6 cm. The lesion extended from approximately the C2 to C6 levels. The right internal and external carotid artery branches were splayed. A subsequent CT examination performed 10 months later showed an increase in the size of the lesion (Figure, A), as well as the interval development of a 1.6-cm, oval-shaped enhancing lesion in the right level IV space posterior to the carotid sheath (Figure, B). Following needle biopsy of both masses, a preoperative carotid angiogram was performed, which demonstrated both the mass at the carotid bifurcation and the smaller level IV mass to be hypervascular (Figure, C). The mass at the carotid bifurcation was embolized.

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