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Clinical Challenge
July 9, 2020

Carotid Space Masses With Liver and Bone Metastases

Author Affiliations
  • 1Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 2Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 3Neuroradiology Section, Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
JAMA Otolaryngol Head Neck Surg. Published online July 9, 2020. doi:10.1001/jamaoto.2020.1107

A young adult nonsmoker patient with a history of asthma presented with a palpable mass on the left side of the neck that had been present for several months, reportedly unchanged. The patient had been treated presumptively for infection with antibiotics, with no improvement. No fever, odynophagia, dysphagia, otalgia, or other constitutional symptoms were reported. Physical examination findings demonstrated a palpable, soft, nontender left level II/III neck mass. Clinical examination findings of the thyroid and upper aerodigestive tract were unremarkable. Contrast-enhanced neck computed tomography (CT) showed a large avidly enhancing mass centered at the left carotid bifurcation splaying the internal and external carotid arteries and extending cranially along the cervical internal carotid artery. The left internal jugular vein was displaced posteriorly. There was also a smaller mass with similar appearance at the right carotid bifurcation (Figure 1A). Contrast-enhanced abdominal CT showed several enhancing masses in the liver (not shown). Based on CT findings, gallium Ga 68 (68Ga) dotatate positron emission tomography (PET)/magnetic resonance imaging (MRI) was performed; results demonstrated intense radiotracer avidity in bilateral carotid space masses, hepatic masses, and numerous CT occult osseous lesions (Figure 1B).

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