Head Lorenzo E. Derchi, MD #{149}Giovanni Serafini, MD #{149}Claudio Luigi Solbiati, MD #{149}Francesco Candiani, MD #{149}Francesco Carlo Bertoglio, MD #{149}Giorgio Rizzatto, MD
Carotid
Body
Tumors:
US
Rabbia, Musante,
MD MD
and Pietro
#{149}
Neck
De Albertis,
Radiology MD
Evaluation’
The ultrasound (US) findings in 20 patients with 23 carotid-body chemodectomas were reviewed. Twentytwo of 23 tumors could be seen at US; the remaining lesion could not be differentiated
from
surrounding
en-
larged lymph nodes resulting from thyroid cancer. The lesions were solid, slightly heterogeneous masses that ranged in size from 1.2 to 5.0 cm and were located within the carotid bifurcation. Pulsed Doppler analysis of blood flow within the tumor mass was possible in eight patients with nine chemodectomas, and low-resistance waveforms were obtained from multiple sites within the mass in all cases.
The
diagnostic
possibility
of a
chemodectoma has to be considered when a solid mass is detected within the carotid bifurcation. On the basis of these findings, as US diagnosis was possible in 18 of 20 patients in the authors’ series. Doppler analysis of the mass to evaluate intratumor blood flow is helpful in differentiating chemodectomas from other solid, nonhypervascular masses. Index terms: Carotid body, neoplasms, 172.3642 #{149}Carotid body, US, 172.12984 #{149}Head and neck neoplasms, 27.325 #{149}Paraganglioma, 172.3642 Radiology
1992;
the Department
of Radiology
b.
Figure 1. (a) Sagittal US scan (7.5-MHz transducer) of right-sided chemodectoma close relationship with the internal carotid artery. The tumor is solid, with many channels. Arrows indicate the carotid bifurcation. (b) Digital subtraction angiogram same tumor demonstrates a hypervascular mass within the carotid bifurcation.
C
body tumors, as chemodectomas,
AROTID
bifurcation arteries.
Varese
The
of the common carotid body
carotid tumors
glomus,
the
vagat
and Most
glomus,
the
netnopenitoneal
of these
lesions
the
aomtic
are
benign,
me-
with malignancy occurring in about 6%. They occur most frequently between the 4th and 6th decades of life, but age
they may be encountered groups. A familial tendency
been reported, bilateral tumors tients
with
in alt has
multiple
tumors
graphic signal quences
images.
intensity with alt pulse sehas been described on mag-
has
received
relatively
attention in the radiology The diagnosis has been on
the
basis
of findings
masses. Only compression nus syndrome.
of this article
The diagnosis is usually clinically and is confirmed
suspected through
analysis
of a mass
(4-7).
is to review
ings in 20 patients with body tumors that were US images and Doppler
neck.
little
literature. shown to be
direct imaging of the lesion in addition, hypervasculamity been detected with pulsed
si-
tomo-
Intermediate
from different sites are not name (1). Carotid body tumors grow slowly and are first seen, in most cases, as palpable, nontender lateral neck a few patients have symptoms or carotid
vascular of the
netic resonance (MR) images, with multiple serpentine areas of tow signat intensity representing flow voids throughout the mass; this is considered a characteristic MR finding (3). To our knowledge, the mote of ultrasound (US) in the diagnosis of chemo-
possible
arising
computed
(CT)
dectomas
and in these patients are often present. Pa-
(c) shows fine
angiographic demonstration of a hypervasculam mass located within the carotid bifurcation (2). Homogeneous enhancement is present on contrast material-enhanced
be-
tong to the group of nonchnomaffin pamagangliomas. Other sites of origin are the jugular glomus, the tympanic
gion.
Ospedale, Busto Arsizio, Italy (L.S.); the Radiology Institute, Universit#{224} di Padova, Padua, Italy (F.C.); the Department of Radiology, Ospedale di Alessandria, Alessandria, Italy (F.M.); and the Department of Radiology, Ospedale di Gorizia, Gorizia, Italy (G.R.). From the 1991 RSNA scientific assembly. Received April 17, 1991; revision requested June i4; revision received July 15; accepted July 22. Address reprint requests to LED. © RSNA, 1992
also known are rela-
tivety rare lesions that arise from the chemomeceptom tissue located at the
gtomus,
182:457-459
I From the Departments of Radiology (LED.) and Surgery (C.B.), Universit#{224} di Genova, Viale Benedetto XV, 16132, Genoa, Italy (LED.); the Department of Radiology, Ospedale di Savona, Savona, Italy (G.S., P.D.A.); the Department of Radiology, Ospedale Molinette, Turin, Italy
(CR.);
a.
at
with US; has Doppler
The the
purpose US
find-
23 carotid detected with studies of the
a
Figure
2.
Axial
US scan (10-MHz
trans-
ducer) shows carotid body tumor (c). Axial scan planes allowed best delineation of the tumor mass within the carotid bifurcation. Straight arrow indicates external carotid ar-
tery;
curved
arrow
indicates
internal
carotid
a.
b.
Figure 3. Axial scans of a right-side chemodectoma (c) were obtained at two different levels (a is caudal to b). (a) The carotid bifurcation (arrow) has an unusual elongated shape, widened by the presence of the carotid body tumor. The origin of the superior thyroid artery (arrowheads) is depicted. (b) The internal (curved arrow) and external (straight arrow) carotid
branches
artery.
a.
are visible;
the external
carotid
artery
b.
is completely
surrounded
AND
We reviewed tients
with
mas,
who
tions
from
There ranged
the US findings
23 carotid were
body i984
in 20 pa-
chemodecto-
examined
January
Tumors
METHODS
at our
institu-
to March
i99i.
were and
located on the
on left
the right side side in 12. One
in Ii pa-
tient had one tumor on each side; another had two chemodectomas on the left side and one on the right side. The lesions were
nontender
masses
in the
lateral
as-
pect of the neck in i9 patients; one patient had an unsuspected carotid body tumor associated nodes
with from
multiple
In the remaining have a palpable atic with
thyroid
lymph
body
arising
from
the
patient
with
three
jugular
lesions
glomus. had
two
The palpa-
ble nodules on the left side, while the contralateral tumor was detected during a complete survey of the neck with US.
-
_458
#{149}Radiolqgy
cases
glomus
two one
with with
built-in
with
path,
sector
linear-array curved
array
Doppler
within patients
the mass was performed with nine tumors; color
surgery;
towed
was
the
in two of the
up). right-side
other and tumor
probes, and probe.
was
was
(one before
to be
was
tumor
flow
in eight Doppler
of these
continues
Angiography
four
diagnosis
at surgery in i8 patients died of unrelated causes the
enlarged
lymph
at physical
examina-
misinterpreted
as an
node.
performed
performed
of in
of the
ous
largest
biopsy
of the
22 of 23 carotid body lesions ranged from 1.2
tumor
mass
with
the vessels was depicted in all cases; the relationship was depicted even more clearly with high-resolution (7.5-10-MHz) scanning
aspiration
vessels.
to 5.0 cm in maximum diameter. They had regular margins and solid, often hypoechoic and heterogeneous, echo patterns; small vascular structures were often visible in them (Fig i). Two cases had cysttike internal spaces. The lesions were contained within the carotid bifurcation. The relationship
fol-
embolization
US depicted tumors. The
the patient with three lesions. CT was performed in seven cases and MR imaging in three. One patient underwent percutanefine-needle
since
was
vascular
RESULTS
scanner,
of blood
possible
Confirmation
US,
mass
in a fine
intratumor
iO-MFIz
Pulsed
imaging
before the
a 5-MHz
water
analysis
tion
from
with
small-parts
mechanical
7.5-MHz a 6.5-MHz
mass
placed
equipment:
examined
with
a 7.5-MHz
also
performed
six with
transducers with
were
were
were
In one case, a retrohad been re-
of real-time
array,
in 19 patients,
chemodectoma
right
Seven
curved
obtained patient
tumor was detected during evaluation of a
symptomatic
of a variety
cases.
carcinoma.
patient, who did not neck mass, an asymptom-
left carotid angiography
clinically
bilateral
medullary
jugular
The US studies
were nine men and I 1 women, who in age from 24 to 74 years. The le-
sions cases
of the
found in two patients. peritoneal chemodectoma moved 4 years earlier. use
mass.
C.
Figure 4. (a) Oblique scan (7.5-MHz transducer) of left-side chemodectoma (c) was obtained with Doppler cursor channel. Arrow indicates the carotid bifurcation. (b) Arterial waveforms with low-resistance pattern were obtained (c) Digital subtraction angiogram enables confirmation of the presence, location, and hypervasculanity of the mass.
MATERIALS
by the tumor
neck
in the
transducers axial plane
(Fig 2). In the patient lesion,
the
external
during of the
with carotid
February
the am-
1992
neck. US imaging can demonstrate tocation, structure, shape, and relationships of the disease process, and on the basis of these findings a preoperative diagnosis can be made in the large majority of cases
(9).
In
our
for diagnosis
tumors
with
US are
of the disease bifurcation Figure 5. Axial image (6.5-MHz curved array) of color Doppler study of a carotid body tumor (c) shows heterogeneous echo pattern.
Color Doppler imaging allows evaluation of close relationships with
carotid
branches
and
both easy of the mass
identification
of
large intratumor blood vessels. Straight arrow indicates external carotid artery; curved arrow indicates internal carotid artery.
was
always
detected
when
analysis was performed nals could be obtained
Doppler
(Fig 4); sigat multiple
sites within the lesions, sets that were not visible
even in yesat US. Also,
color flow mapping allowed identification of intratumor blood vessels that were not visible with US imaging alone (Fig 5). In one patient with a chemodectoma associated with multiple enlarged lymph nodes from medutlamy
thyroid
cancer,
the
carotid
body tumor could not be diffementiated from surrounding lesions. In this patient, however, Doppler evaluation of neck lesions was not performed. On the basis of imaging and Dopplem findings, a prospective diagnosis of chemodectoma could be suspected in 18 of 20 patients in our series. US was
unable
to image
the
associated
lesions arising from the jugular gbmus. In patients who underwent CT imaging of the neck, solid masses demonstrated
were
after
contrast
en-
hancement. In patients who underwent MR imaging, lesions of intermediate signal intensity with a few thin vascular areas within were depicted. DISCUSSION In
patients
US studies
with
demonstrate
body the
tionship
close
tumors, mela-
of the tumor mass with the carotid artery and hypervasculamity at duplex Doppler examination and/or colon Doppler imaging (4-8). US has a wellestablished mote in the study of patients with space-occupying lesions of the
Volume
182
#{149} Number
2
and
suggestive
within
location
the carotid that or that side of the detail pro-
(b) demonstration
nosis
of multiple
a solitary the carotid
sidered ing
lymph
nodule
nodes.
is detected
bifurcation,
of chemodectoma
the diag-
has
to be con-
as the first possibility.
other
US parameters,
noted that a variety patterns have been lesions,
and
only
can be safety of their
Regard-
it must
of solid observed purely
cystic
differentiated
be
structural in these masses
on the basis
In our series, the diagnosis of carotid body tumor was suggested in alt but two patients on the basis of findings at US imaging
alone.
A prospective
and
one
nodule
on
the
other
all solid
nodules
relatively
Vascular
anomalies
in the
neck
are
easily
detected with Doppler US, and some help can also be obtained in the examination of solid masses. Both continuouswave and pulsed (duplex and colon) Doppler equipment have been proved able to demonstrate intratumon blood flow in chemodectomas, thus providing help in differentiating them from other solid, nonhypervasculam neck masses (6-8). Doppler signals can be heard from vessels at the hilum of enlarged lymph
nodes
bilateral
other those
cervical chemodectomas, from the vagal gtomus
associated.
It must
study
of lesions
be-
frequently
and
such as (12), can be
be noted
facilitate evaluation only these patients
that
US can
of neck lesions in and cannot facilitate arising
within
the
tern-
poral bone (chemodectomas from the jugular gbomus were associated with carotid body tumors in two patients in our series). CT and/or MR imaging can be performed to assess the presence of multiple lesions and to locate them accurately.
However,
precise
evaluation
of
tumor vascularization is not possible with CT and MR imaging; performance of angiography sels
is still
feeding
the
can also be used these
lesions.
required
for
evaluation tumor
(2).
accu-
of the yesAngiognaphy
for embolization
of
#{149}
(10);
References 1. 2.
were interpreted as being caused by metastatic disease. Doppler analysis of the lesions was not performed. Doppler studies have been suggested as helpful differential tools in patients with neck lesions that are difficult to diagnose.
since
occur
side.
In the remaining case with enlarged lymph nodes from medullary thyroid carcinoma,
is needed,
sions
diag-
nosis was not obtained in one patient with two nodules on one side of the neck
furcation
mate preoperative
structure.
inflammatory
carotid
(a) accurate
process
the tumor nodule is solitary theme is one nodule on each neck. The exquisite anatomic vided with high-frequency, high-mesolution US equipment allows both easy identification of the anatomic relationships of the tumor with vessels of the neck and demonstration of multiple nodules. This latter finding is usually When within
teny and its branches were completely encased by the mass (Fig 3). Low-resistance arterial blood flow
the most important of carotid body
opinion,
criteria
ance, the demonstration of a large mass within the carotid bifurcation is most likely to be a carotid body tumor. In our opinion, US can be considered the first imaging procedure to be emptoyed in patients with suspected carotid body tumors because it is noninvasive and because it has strong diagnostic capabilities in this field. However, when a carotid body tumor is demonstrated, a complete survey with US of both the entire neck and the carotid bi-
from
arteries encased by confluent tymphomatous masses (ii); and with use of modern, highly sensitive equipment, even from the panenchyma of large adenopathies of both inflammatory and malignant origin. However, large inflammatory lymph nodes have a rather characteristic echogenic
appearance central hilum
because an can usually be
observed.
In the absence
of this appear-
3.
4. 5.
6.
7.
8.
9.
10.
Staats EF, Brown RL, Smith RR. Carotid body tumors, benign and malignant. Laryngoscope 1966; 76:907-916. Brismar J. Angiography of chemodectomas of the neck. Acta Radiol 1980; 21:689-696. Som PM, Sacher M, Stollman AL, Biller HF, Lawson W. Common tumors of the parapharyngeal space: refined imaging diagnosis. Radiology 1988; 169:81-85. Gooding GAW. Gray-scale ultrasound detection of carotid body tumors. Radiology 1979; 132:409-410. Makarainen H, Paivansalo M, Hyrynkangas K, Leinonen A, Siniluoto T. Sonographic pattents of carotid body tumors. JCU 1986; 14: 373-375. Gritzmann N, Herold C, Hallerj, Karnel F, Schwaighofer B. Duplex sonography of himors ofthe carotid body. Cardiovasc Intervent Radiol 1987; 10:280-284. Shulak JM, O’Donovan PB, Paushter DM, Lanzieri CF. Color flow Doppler ofcarotid body t araganglioma. J Ultrasound Med 1989; 8:519Lewis RR, Beasley MG, Coghlan BA, Yates AK, Gosling RG. Demonstration of a carotid body tumor by ultrasound. Br J Radiol 1980; 53:368371. Solbiati L, Bellotti E, Rizzatto G. Patologie extraparenchimali della regione cervicale. In: Rizzatto G, Solbiati L, eds. Ecografla clinica delle strutture superficiali. Milan: Masson Itaha, 1985; 81-90. Morton MJ, Charboneau JW, Banks PM. Inguinal lymphadenopathy simulating a false aneurysm on color-flow Doppler sonography. AJR
11.
12.
1q88; 151:115-116.
Majer MC, Hess CF, KOlbel G, Schmiedl U. Small arteries in peripheral lymph nodes: a specific US sign of lymphomatous involvement. Radiology 1988; 168:241-243. Raby N. Ultrasonographic appearances of glomus vagale tumour. BrJ Radiol 1987; 61:
246-249.
Radiology
459
#{149}
Carotid
Body
Tumors:
US
Rabbia, Musante,
MD MD
and Pietro
#{149}
Neck
De Albertis,
Radiology MD
Evaluation’
The ultrasound (US) findings in 20 patients with 23 carotid-body chemodectomas were reviewed. Twentytwo of 23 tumors could be seen at US; the remaining lesion could not be differentiated
from
surrounding
en-
larged lymph nodes resulting from thyroid cancer. The lesions were solid, slightly heterogeneous masses that ranged in size from 1.2 to 5.0 cm and were located within the carotid bifurcation. Pulsed Doppler analysis of blood flow within the tumor mass was possible in eight patients with nine chemodectomas, and low-resistance waveforms were obtained from multiple sites within the mass in all cases.
The
diagnostic
possibility
of a
chemodectoma has to be considered when a solid mass is detected within the carotid bifurcation. On the basis of these findings, as US diagnosis was possible in 18 of 20 patients in the authors’ series. Doppler analysis of the mass to evaluate intratumor blood flow is helpful in differentiating chemodectomas from other solid, nonhypervascular masses. Index terms: Carotid body, neoplasms, 172.3642 #{149}Carotid body, US, 172.12984 #{149}Head and neck neoplasms, 27.325 #{149}Paraganglioma, 172.3642 Radiology
1992;
the Department
of Radiology
b.
Figure 1. (a) Sagittal US scan (7.5-MHz transducer) of right-sided chemodectoma close relationship with the internal carotid artery. The tumor is solid, with many channels. Arrows indicate the carotid bifurcation. (b) Digital subtraction angiogram same tumor demonstrates a hypervascular mass within the carotid bifurcation.
C
body tumors, as chemodectomas,
AROTID
bifurcation arteries.
Varese
The
of the common carotid body
carotid tumors
glomus,
the
vagat
and Most
glomus,
the
netnopenitoneal
of these
lesions
the
aomtic
are
benign,
me-
with malignancy occurring in about 6%. They occur most frequently between the 4th and 6th decades of life, but age
they may be encountered groups. A familial tendency
been reported, bilateral tumors tients
with
in alt has
multiple
tumors
graphic signal quences
images.
intensity with alt pulse sehas been described on mag-
has
received
relatively
attention in the radiology The diagnosis has been on
the
basis
of findings
masses. Only compression nus syndrome.
of this article
The diagnosis is usually clinically and is confirmed
suspected through
analysis
of a mass
(4-7).
is to review
ings in 20 patients with body tumors that were US images and Doppler
neck.
little
literature. shown to be
direct imaging of the lesion in addition, hypervasculamity been detected with pulsed
si-
tomo-
Intermediate
from different sites are not name (1). Carotid body tumors grow slowly and are first seen, in most cases, as palpable, nontender lateral neck a few patients have symptoms or carotid
vascular of the
netic resonance (MR) images, with multiple serpentine areas of tow signat intensity representing flow voids throughout the mass; this is considered a characteristic MR finding (3). To our knowledge, the mote of ultrasound (US) in the diagnosis of chemo-
possible
arising
computed
(CT)
dectomas
and in these patients are often present. Pa-
(c) shows fine
angiographic demonstration of a hypervasculam mass located within the carotid bifurcation (2). Homogeneous enhancement is present on contrast material-enhanced
be-
tong to the group of nonchnomaffin pamagangliomas. Other sites of origin are the jugular glomus, the tympanic
gion.
Ospedale, Busto Arsizio, Italy (L.S.); the Radiology Institute, Universit#{224} di Padova, Padua, Italy (F.C.); the Department of Radiology, Ospedale di Alessandria, Alessandria, Italy (F.M.); and the Department of Radiology, Ospedale di Gorizia, Gorizia, Italy (G.R.). From the 1991 RSNA scientific assembly. Received April 17, 1991; revision requested June i4; revision received July 15; accepted July 22. Address reprint requests to LED. © RSNA, 1992
also known are rela-
tivety rare lesions that arise from the chemomeceptom tissue located at the
gtomus,
182:457-459
I From the Departments of Radiology (LED.) and Surgery (C.B.), Universit#{224} di Genova, Viale Benedetto XV, 16132, Genoa, Italy (LED.); the Department of Radiology, Ospedale di Savona, Savona, Italy (G.S., P.D.A.); the Department of Radiology, Ospedale Molinette, Turin, Italy
(CR.);
a.
at
with US; has Doppler
The the
purpose US
find-
23 carotid detected with studies of the
a
Figure
2.
Axial
US scan (10-MHz
trans-
ducer) shows carotid body tumor (c). Axial scan planes allowed best delineation of the tumor mass within the carotid bifurcation. Straight arrow indicates external carotid ar-
tery;
curved
arrow
indicates
internal
carotid
a.
b.
Figure 3. Axial scans of a right-side chemodectoma (c) were obtained at two different levels (a is caudal to b). (a) The carotid bifurcation (arrow) has an unusual elongated shape, widened by the presence of the carotid body tumor. The origin of the superior thyroid artery (arrowheads) is depicted. (b) The internal (curved arrow) and external (straight arrow) carotid
branches
artery.
a.
are visible;
the external
carotid
artery
b.
is completely
surrounded
AND
We reviewed tients
with
mas,
who
tions
from
There ranged
the US findings
23 carotid were
body i984
in 20 pa-
chemodecto-
examined
January
Tumors
METHODS
at our
institu-
to March
i99i.
were and
located on the
on left
the right side side in 12. One
in Ii pa-
tient had one tumor on each side; another had two chemodectomas on the left side and one on the right side. The lesions were
nontender
masses
in the
lateral
as-
pect of the neck in i9 patients; one patient had an unsuspected carotid body tumor associated nodes
with from
multiple
In the remaining have a palpable atic with
thyroid
lymph
body
arising
from
the
patient
with
three
jugular
lesions
glomus. had
two
The palpa-
ble nodules on the left side, while the contralateral tumor was detected during a complete survey of the neck with US.
-
_458
#{149}Radiolqgy
cases
glomus
two one
with with
built-in
with
path,
sector
linear-array curved
array
Doppler
within patients
the mass was performed with nine tumors; color
surgery;
towed
was
the
in two of the
up). right-side
other and tumor
probes, and probe.
was
was
(one before
to be
was
tumor
flow
in eight Doppler
of these
continues
Angiography
four
diagnosis
at surgery in i8 patients died of unrelated causes the
enlarged
lymph
at physical
examina-
misinterpreted
as an
node.
performed
performed
of in
of the
ous
largest
biopsy
of the
22 of 23 carotid body lesions ranged from 1.2
tumor
mass
with
the vessels was depicted in all cases; the relationship was depicted even more clearly with high-resolution (7.5-10-MHz) scanning
aspiration
vessels.
to 5.0 cm in maximum diameter. They had regular margins and solid, often hypoechoic and heterogeneous, echo patterns; small vascular structures were often visible in them (Fig i). Two cases had cysttike internal spaces. The lesions were contained within the carotid bifurcation. The relationship
fol-
embolization
US depicted tumors. The
the patient with three lesions. CT was performed in seven cases and MR imaging in three. One patient underwent percutanefine-needle
since
was
vascular
RESULTS
scanner,
of blood
possible
Confirmation
US,
mass
in a fine
intratumor
iO-MFIz
Pulsed
imaging
before the
a 5-MHz
water
analysis
tion
from
with
small-parts
mechanical
7.5-MHz a 6.5-MHz
mass
placed
equipment:
examined
with
a 7.5-MHz
also
performed
six with
transducers with
were
were
were
In one case, a retrohad been re-
of real-time
array,
in 19 patients,
chemodectoma
right
Seven
curved
obtained patient
tumor was detected during evaluation of a
symptomatic
of a variety
cases.
carcinoma.
patient, who did not neck mass, an asymptom-
left carotid angiography
clinically
bilateral
medullary
jugular
The US studies
were nine men and I 1 women, who in age from 24 to 74 years. The le-
sions cases
of the
found in two patients. peritoneal chemodectoma moved 4 years earlier. use
mass.
C.
Figure 4. (a) Oblique scan (7.5-MHz transducer) of left-side chemodectoma (c) was obtained with Doppler cursor channel. Arrow indicates the carotid bifurcation. (b) Arterial waveforms with low-resistance pattern were obtained (c) Digital subtraction angiogram enables confirmation of the presence, location, and hypervasculanity of the mass.
MATERIALS
by the tumor
neck
in the
transducers axial plane
(Fig 2). In the patient lesion,
the
external
during of the
with carotid
February
the am-
1992
neck. US imaging can demonstrate tocation, structure, shape, and relationships of the disease process, and on the basis of these findings a preoperative diagnosis can be made in the large majority of cases
(9).
In
our
for diagnosis
tumors
with
US are
of the disease bifurcation Figure 5. Axial image (6.5-MHz curved array) of color Doppler study of a carotid body tumor (c) shows heterogeneous echo pattern.
Color Doppler imaging allows evaluation of close relationships with
carotid
branches
and
both easy of the mass
identification
of
large intratumor blood vessels. Straight arrow indicates external carotid artery; curved arrow indicates internal carotid artery.
was
always
detected
when
analysis was performed nals could be obtained
Doppler
(Fig 4); sigat multiple
sites within the lesions, sets that were not visible
even in yesat US. Also,
color flow mapping allowed identification of intratumor blood vessels that were not visible with US imaging alone (Fig 5). In one patient with a chemodectoma associated with multiple enlarged lymph nodes from medutlamy
thyroid
cancer,
the
carotid
body tumor could not be diffementiated from surrounding lesions. In this patient, however, Doppler evaluation of neck lesions was not performed. On the basis of imaging and Dopplem findings, a prospective diagnosis of chemodectoma could be suspected in 18 of 20 patients in our series. US was
unable
to image
the
associated
lesions arising from the jugular gbmus. In patients who underwent CT imaging of the neck, solid masses demonstrated
were
after
contrast
en-
hancement. In patients who underwent MR imaging, lesions of intermediate signal intensity with a few thin vascular areas within were depicted. DISCUSSION In
patients
US studies
with
demonstrate
body the
tionship
close
tumors, mela-
of the tumor mass with the carotid artery and hypervasculamity at duplex Doppler examination and/or colon Doppler imaging (4-8). US has a wellestablished mote in the study of patients with space-occupying lesions of the
Volume
182
#{149} Number
2
and
suggestive
within
location
the carotid that or that side of the detail pro-
(b) demonstration
nosis
of multiple
a solitary the carotid
sidered ing
lymph
nodule
nodes.
is detected
bifurcation,
of chemodectoma
the diag-
has
to be con-
as the first possibility.
other
US parameters,
noted that a variety patterns have been lesions,
and
only
can be safety of their
Regard-
it must
of solid observed purely
cystic
differentiated
be
structural in these masses
on the basis
In our series, the diagnosis of carotid body tumor was suggested in alt but two patients on the basis of findings at US imaging
alone.
A prospective
and
one
nodule
on
the
other
all solid
nodules
relatively
Vascular
anomalies
in the
neck
are
easily
detected with Doppler US, and some help can also be obtained in the examination of solid masses. Both continuouswave and pulsed (duplex and colon) Doppler equipment have been proved able to demonstrate intratumon blood flow in chemodectomas, thus providing help in differentiating them from other solid, nonhypervasculam neck masses (6-8). Doppler signals can be heard from vessels at the hilum of enlarged lymph
nodes
bilateral
other those
cervical chemodectomas, from the vagal gtomus
associated.
It must
study
of lesions
be-
frequently
and
such as (12), can be
be noted
facilitate evaluation only these patients
that
US can
of neck lesions in and cannot facilitate arising
within
the
tern-
poral bone (chemodectomas from the jugular gbomus were associated with carotid body tumors in two patients in our series). CT and/or MR imaging can be performed to assess the presence of multiple lesions and to locate them accurately.
However,
precise
evaluation
of
tumor vascularization is not possible with CT and MR imaging; performance of angiography sels
is still
feeding
the
can also be used these
lesions.
required
for
evaluation tumor
(2).
accu-
of the yesAngiognaphy
for embolization
of
#{149}
(10);
References 1. 2.
were interpreted as being caused by metastatic disease. Doppler analysis of the lesions was not performed. Doppler studies have been suggested as helpful differential tools in patients with neck lesions that are difficult to diagnose.
since
occur
side.
In the remaining case with enlarged lymph nodes from medullary thyroid carcinoma,
is needed,
sions
diag-
nosis was not obtained in one patient with two nodules on one side of the neck
furcation
mate preoperative
structure.
inflammatory
carotid
(a) accurate
process
the tumor nodule is solitary theme is one nodule on each neck. The exquisite anatomic vided with high-frequency, high-mesolution US equipment allows both easy identification of the anatomic relationships of the tumor with vessels of the neck and demonstration of multiple nodules. This latter finding is usually When within
teny and its branches were completely encased by the mass (Fig 3). Low-resistance arterial blood flow
the most important of carotid body
opinion,
criteria
ance, the demonstration of a large mass within the carotid bifurcation is most likely to be a carotid body tumor. In our opinion, US can be considered the first imaging procedure to be emptoyed in patients with suspected carotid body tumors because it is noninvasive and because it has strong diagnostic capabilities in this field. However, when a carotid body tumor is demonstrated, a complete survey with US of both the entire neck and the carotid bi-
from
arteries encased by confluent tymphomatous masses (ii); and with use of modern, highly sensitive equipment, even from the panenchyma of large adenopathies of both inflammatory and malignant origin. However, large inflammatory lymph nodes have a rather characteristic echogenic
appearance central hilum
because an can usually be
observed.
In the absence
of this appear-
3.
4. 5.
6.
7.
8.
9.
10.
Staats EF, Brown RL, Smith RR. Carotid body tumors, benign and malignant. Laryngoscope 1966; 76:907-916. Brismar J. Angiography of chemodectomas of the neck. Acta Radiol 1980; 21:689-696. Som PM, Sacher M, Stollman AL, Biller HF, Lawson W. Common tumors of the parapharyngeal space: refined imaging diagnosis. Radiology 1988; 169:81-85. Gooding GAW. Gray-scale ultrasound detection of carotid body tumors. Radiology 1979; 132:409-410. Makarainen H, Paivansalo M, Hyrynkangas K, Leinonen A, Siniluoto T. Sonographic pattents of carotid body tumors. JCU 1986; 14: 373-375. Gritzmann N, Herold C, Hallerj, Karnel F, Schwaighofer B. Duplex sonography of himors ofthe carotid body. Cardiovasc Intervent Radiol 1987; 10:280-284. Shulak JM, O’Donovan PB, Paushter DM, Lanzieri CF. Color flow Doppler ofcarotid body t araganglioma. J Ultrasound Med 1989; 8:519Lewis RR, Beasley MG, Coghlan BA, Yates AK, Gosling RG. Demonstration of a carotid body tumor by ultrasound. Br J Radiol 1980; 53:368371. Solbiati L, Bellotti E, Rizzatto G. Patologie extraparenchimali della regione cervicale. In: Rizzatto G, Solbiati L, eds. Ecografla clinica delle strutture superficiali. Milan: Masson Itaha, 1985; 81-90. Morton MJ, Charboneau JW, Banks PM. Inguinal lymphadenopathy simulating a false aneurysm on color-flow Doppler sonography. AJR
11.
12.
1q88; 151:115-116.
Majer MC, Hess CF, KOlbel G, Schmiedl U. Small arteries in peripheral lymph nodes: a specific US sign of lymphomatous involvement. Radiology 1988; 168:241-243. Raby N. Ultrasonographic appearances of glomus vagale tumour. BrJ Radiol 1987; 61:
246-249.
Radiology
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#{149}
