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Carotid Body Tumor Imaging:"Paraganglioma, Chemidectoma"

Author(s): Jalal Jalalshokouhi

Journal: Iranian Journal of Radiology
ISSN 1735-1065

Volume: 7;
Issue: S1;
Start page: 61;
Date: 2010;
Original page

Keywords: keyword

Introduction: Carotid body tumor is a rare benign tumor originating from cells of neural crest tissue. It could present with Horner's syndrome. This tumor is rare and comprises 0.5% of all neoplasms. A familial incidence with autosomal dominant transmission has been reported. "nI have a series of five patients from a known family with one death during surgery because of carotid artery rupturing, others were diagnosed by color Doppler US and dynamic CT scan. Generally, it is sporadic and more frequently seen in high-altitude living people."nSex incidence is approximately equal, "little bit more frequent in the female"."nA characteristic saddle deformity is seen in invasive angiography."nSymptoms are nonspecific; such as, headache, dizziness, tinnitus, loss of hearing acuity, hoarseness, vocal cord or hypoglossal nerve paralysis and syncope. Horner's syndrome is due to sympathetic chain involvement."nThree stages or types of disease have been described by Shambling and colleagues "nFirst, minimally involved internal carotid artery "sub-adventitial""nSecond, partial incorporation of the sheath of internal carotid artery"nThe third type is encircling of internal carotid artery with dense adherence"nImaging: High frequency, high-resolution ultrasonography and color Doppler study are necessary to see blood flow in the artery, bifurcation widening and blood flow in the tumor (low resistance)."nSpiral dynamic X-ray CT: Spiral CT with MPR'S and 3D-angiography is the best imaging to show tumor vascularity and the internal carotid lumen."nDSA or invasive angiography is used for preoperative embolization (larger than 2 cm) just before surgery (gold standard)."nMRI with dynamic and without GD and MRA could replace X-ray CT scan."nTreatment is surgery, embolization and radiation therapy."nNinety-seven patients have been reported from Iran by Mohammad Taghi Salehian as an original article."nRare statements: A malignant unilateral chemodectoma may appear and metastasize to the bone in 6-12.5% of the cases. The abdominal wall is another rare location of metastasis."nA sex-linked genetic trait is possible. "nAll bilateral tumor cases are benign. "n90% of tumors are unilateral and 10% are bilateral. "nSporadic forms are more common than the inherited variety."n65% of head and neck paragangliomas are carotid body tumors."nClassification is sporadic, familial and hyperplastic."nThe common age involvement is the fifth decade, but in MENS (multiple endocrine neoplasia) syndrome, it develops in younger patients."nCarotid body tumors have been reported in siblings of a Turkish family together with the involvement of adrenal pheochromocytomas."nDifferential Diagnosis: The main differential diagnoses are lymphadenopathy, bronchial cleft cyst, metastatic carcinoma, lymphoma, neurogenic tumors, salivary gland tumors, aneurysm, giant cell arteries, hematoma, carotid calcification or stone.
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