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Clinical Problem Solving: Radiology
November 2004

Radiology Quiz Case 2—Diagnosis

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2004;130(11):1343-1344. doi:10.1001/archotol.130.11.1343

The mass was excised and a preliminary diagnosis of paraganglioma was made. Before pathologic examination of the tissue, the high vascularity shown in the ultrasound, MRIs, and selective angiograms strongly suggested that the mass was a paraganglioma. There are 2 methods of treating a paraganglioma: (1) surgically excising it or (2) shrinking and replacing it with fibrous tissue through radiotherapy.1 Six to 12 hours before any surgical procedure is attempted, selective embolization of the feeding vessel, usually the ascending pharyngeal artery, is performed to reduce bleeding during surgery as well as to shrink the mass.1 In the present case, selective embolization was impossible because the vessels were connected between the spinal artery system and the right vertebral artery. Any reflux of the embolization material into the spinal artery system might have caused severe sensory and/or motor deficits.

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