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Clinical Challenge
Radiology
October 2015

A Puzzle in the Carotid Space

Author Affiliations
  • 1Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai, India
  • 2Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
  • 3Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, India
JAMA Otolaryngol Head Neck Surg. 2015;141(10):941-942. doi:10.1001/jamaoto.2015.2062

A man in his 20s presented with a painless, gradually increasing swelling in the right side of the neck of 6 years’ duration. There was no history of dysphagia, hoarseness of voice, dyspnea, or constitutional symptoms, such as fever, weight loss, or night sweats. Clinical examination revealed a 7 × 6-cm, well-defined, firm, nontender swelling extending from the angle of the mandible to the clavicle. Oropharyngeal examination revealed a mucosal bulge on the lateral pharyngeal wall with normal overlying mucosa. A computed tomographic (CT) scan of the neck was performed, which revealed a solid 7 × 8 × 10-cm right carotid space mass, with a few cystic areas and coarse specks of calcification within (Figure, A, yellow arrowhead). It showed heterogeneous postcontrast enhancement, predominantly around the calcific foci. It extended from the C2 to D1 vertebral level and displaced the right common carotid artery and internal jugular vein anterolaterally (Figure, A, red arrowhead). Fat planes around the mass were well maintained (Figure, B, arrowheads), and there was no bone destruction. No cervical lymphadenopathy was noted. A biopsy was performed from the mass (Figure, C and D).

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