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Clinical Problem Solving
December 2014

Carotid Space Mass

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medical College, New York, New York
JAMA Otolaryngol Head Neck Surg. 2014;140(12):1237-1238. doi:10.1001/jamaoto.2014.2523

A man in his 40s presented with a 3-month history of sore throat and neck discomfort. The patient was an active smoker from Georgia, the country fourth most affected by the Chernobyl nuclear accident in Ukraine. Findings from his physical examination were significant for a normal thyroid but with a vague feeling of fullness in the left side of the neck. The patient underwent neck ultrasonography, which revealed a heterogeneous avascular lesion of the left side of the neck that encircled the carotid artery. On magnetic resonance imaging (MRI) there was a homogeneous T1-weighted hypointense, T2-weighted intermediate-intensity, uniformly enhancing mass that also demonstrated restricted diffusion (Figure, A-C). The mass, which encased the left common carotid artery, extended from the arch at the carotid origin superiorly to the level of C5. On positron emission tomography (PET), a mass corresponding to that seen on MRI was fluorodeoxyglucose F 18 (FDG)-avid (Figure, D). The patient underwent a fine-needle aspiration and incisional biopsy of the carotid space mass.