R. NICKBRYANMDS. JAMESZINREICHMD
A 68-YEAR-OLD man presented to the internal medicine service with a 2-day history of rectal bleeding (bright-red blood), a temperature of 39.6°C, and leukocytosis. His medical history was insignificant. A barium enema and a small-bowel follow-through revealed no lesions. Colonoscopy demonstrated no abnormalities. Two days later, the patient developed mild dysphagia and a mass in the right side of his neck. Prophylactic intravenous broad-spectrum antibiotic therapy was initiated, and the otolaryngology service was consulted. Physical examination revealed a 5-cm mobile neck mass that was tender and pulsatile to palpation. There was diminished pulsation of the ipsilateral superficial temporal artery. There were no cervical bruits or thrills. The results of the rest of the physical examination, including flexible laryngoscopy and full neurological assessment, were normal. A computed tomographic scan (Figure 1) revealed a 4.0 × 4.5-cm rim-enhancing mass in the carotid space. Within the mass, there were hypodense and hyperdense areas, as well as evidence of inflammation of the subcutaneous fat extending into the right oropharyngeal and hypopharyngeal walls. An arteriogram revealed a defect at the level of the carotid bifurcation (Figure 2, arrow, and Figure 3, arrow). Blood cultures were positive for Salmonella.
Yoskovitch A, Hier MP, Mohr G, Sheiner N, Tampieri D, Black MJ. Imaging Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2000;126(6):792. doi:10.1001/archotol.126.6.792