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Sleiay M, Alsmoudi H, Alqreea M, Marina S, Kanaan AM, Aljammal MA. A 37-year-old female with a carotid body tumor (paraganglioma): A rare case report from Syria. Int J Surg Case Rep 2024; 122:110157. [PMID: 39151394 DOI: 10.1016/j.ijscr.2024.110157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/07/2024] [Accepted: 08/10/2024] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE This case study presents the clinical details of a 37-year-old woman who presented with an asymptomatic swelling in the right supraclavicular region, ultimately diagnosed as a carotid body tumor (CBT). CASE PRESENTATION The patient's medical background, which included her brother's CBT, prompted further investigation. Upon clinical examination and imaging studies, a tissue mass surrounding the right internal carotid artery was identified. Subsequent surgical resection of the tumor was performed, and histological analysis confirmed a neoplastic proliferation consistent with paraganglioma. CLINICAL DISCUSSION This case highlights the significance of taking into account familial history and conducting comprehensive diagnostic assessments for patients exhibiting similar symptoms. The successful multidisciplinary management of this rare tumor underscores the importance of early detection and appropriate therapeutic interventions. CONCLUSION This report offers valuable insights into the clinical presentation, diagnostic process, and treatment of CBTs, emphasizing the necessity for a comprehensive approach to managing this uncommon neoplasm.
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Affiliation(s)
- Mouhammed Sleiay
- Faculty of Medicine, Hama University, Hama, Syrian Arab Republic.
| | - Hasan Alsmoudi
- Faculty of Medicine, Hama University, Hama, Syrian Arab Republic
| | - Mohammed Alqreea
- Orthopedic Surgery Department, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Sliman Marina
- Faculty of Medicine, Damascus university, Damascus, Syrian Arab Republic
| | - Ahmad Mostafa Kanaan
- Surgery Department, Alwatani Hospital, Hama University, Hama, Syrian Arab Republic
| | - Makia Ali Aljammal
- Surgery Department, Alwatani Hospital, Hama University, Hama, Syrian Arab Republic
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Kakamad FH, Mustafa MN, Yasin SW, Xalid SS, Mohammed AA, Othman S, Hiwa DS, Abdullah HO, Abdalla BA, Nasralla HA, Ahmed SM, Mustafa AM, Hassan SH, Hussein BO. Carotid body tumor: characteristics and surgical outcome. J Cardiothorac Surg 2024; 19:473. [PMID: 39085894 PMCID: PMC11289908 DOI: 10.1186/s13019-024-02951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 06/30/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Carotid body tumors are uncommon neuroendocrine growths near the carotid bifurcation. While some advocate preoperative embolization to minimize bleeding, others avoid it due to complications. This study shares the experience of a single center in managing patients with carotid body tumors without practicing preoperative embolization. METHODS This was a cross-sectional study of patients with carotid body tumors managed between 2020 and 2024. Data were collected from the hospital's registry. When necessary, routine blood tests, neck ultrasonography, and computed tomography scans were conducted. The tumors were categorized according to Shamblin's classification. The average duration of follow-up was 20 months. RESULTS The study involved 25 patients, 22 (88%) females and 3 (12%) males. Their ages ranged from 27 to 85 years old. Twenty (80%) cases presented with neck swelling, and six (24%) had a positive medical history. Tumors were mainly on the right side (52%), with 20 (80%) showing ill-defined neck masses. Tumor sizes ranged from 1.5 to 7 cm, with Shamblin type II tumors being discovered in the majority of cases (72%). Types of tumors were significantly associated with the tumor size (p-value < 0.05). Blood transfusion was required in five cases (20%), three from type III and two from type II, with none from type I (p-value = 0.001). Temporary neurological deficits occurred in 3 cases (12%). No functional impairment or mortality was recorded. CONCLUSIONS Carotid body tumors are rare tumors with an unknown etiology. Operation without practicing preoperative embolization may be feasible with an acceptable outcome.
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Affiliation(s)
- Fahmi Hussein Kakamad
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Building 11, Apartment 50, Sulaymaniyah, Sulaymaniyah, Kurdistan, 46001, Iraq.
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq.
- Kscien Organization for Scientific Research, Hamdi Street, Azadi Mall, Sulaymaniyah, Kurdistan, Iraq.
| | - Mihr Naif Mustafa
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Building 11, Apartment 50, Sulaymaniyah, Sulaymaniyah, Kurdistan, 46001, Iraq
| | - Shara Wahdaldeen Yasin
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Building 11, Apartment 50, Sulaymaniyah, Sulaymaniyah, Kurdistan, 46001, Iraq
| | - Shanga Sherzad Xalid
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Building 11, Apartment 50, Sulaymaniyah, Sulaymaniyah, Kurdistan, 46001, Iraq
| | - Ayoob A Mohammed
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Building 11, Apartment 50, Sulaymaniyah, Sulaymaniyah, Kurdistan, 46001, Iraq
| | - Snur Othman
- Kscien Organization for Scientific Research, Hamdi Street, Azadi Mall, Sulaymaniyah, Kurdistan, Iraq
| | - Dilan S Hiwa
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Hiwa O Abdullah
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Kscien Organization for Scientific Research, Hamdi Street, Azadi Mall, Sulaymaniyah, Kurdistan, Iraq
| | - Berun A Abdalla
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Kscien Organization for Scientific Research, Hamdi Street, Azadi Mall, Sulaymaniyah, Kurdistan, Iraq
| | - Hawkar A Nasralla
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Sasan M Ahmed
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Kscien Organization for Scientific Research, Hamdi Street, Azadi Mall, Sulaymaniyah, Kurdistan, Iraq
| | - Ayman M Mustafa
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Shko H Hassan
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Bushra O Hussein
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
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3
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Xie Y, Tang W, Chen X, Bai X, Chen Y. Elevated 68Ga-FAPI Activity in Benign Carotid Body Tumors. Clin Nucl Med 2024:00003072-990000000-01216. [PMID: 39010319 DOI: 10.1097/rlu.0000000000005364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
ABSTRACT We present 68Ga-FAPI PET/CT findings of benign carotid body tumor in a 33-year-old woman. Benign carotid body tumor demonstrated intense tracer uptakes on 68Ga-FAPI PET/CT. Our case suggests that benign carotid body tumors should be considered in the differential diagnosis of neck mass with elevated 68Ga-FAPI activity.
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Affiliation(s)
| | | | | | - Xue Bai
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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4
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Wang H, Li Z, Yao C, Wang M, Hu Z, Wu R, Chang G. Perioperative evaluation and follow-up analysis of carotid body tumor by Color Doppler Ultrasound. Ann Vasc Surg 2024:S0890-5096(24)00396-0. [PMID: 39009121 DOI: 10.1016/j.avsg.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/17/2024] [Accepted: 05/02/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES The value of Color Doppler Ultrasound (CDU) for perioperative evaluation and follow-up outcomes of carotid body tumor (CBT) remains elusive. This study aimed to investigate the role of CDU in CBT in our center. METHODS From January 2015 to December 2020, 75 patients with CBT were included in the study. Computed Tomography Angiography (CTA) and CDU data of patients were collected and analyzed. The postoperative recovery and follow-up outcomes were summarized. RESULTS A total of 91 CBTs in 75 patients were included in the study. 73.3% of patients had unilateral lesions, while 26.7% had bilateral lesions. Lesions were categorized as Shamblin I (4.4%), Shamblin II (52.7%), and Shamblin III (42.9%). 79.5% lesions were treated by surgical resection, 12.3% were treated by surgical resection with internal carotid artery reconstructed by artificial vessel, while 8.2% were treated by surgical resection with internal carotid artery reconstructed by autogenous great saphenous vein. Compared with CTA, the sensitivity of CDU for detection of CBT was 96.7%, the sensitivity and specificity of CDU for detection of Shamblin Ⅰ lesions were both 100%, the sensitivity and specificity for Shamblin Ⅱ were 100% and 72.1%, respectively, while the sensitivity and specificity for Shamblin Ⅲ were 69.2% and 100%, respectively. There were no statistically significant differences between CTA and CDU for detection of the maximal diameter, volume of CBT and distance between the end of the tumor and the mastoid process. 79.7% of patients were followed up with CDU. Recurrence of CBT occurred in 1 patient. CDU showed that stenosis and occlusion of artificial vessel occurred in 1 and 6 patients, respectively. Occlusion of autogenous great saphenous vein was found in 2 cases. CONCLUSIONS CDU can accurately diagnose Shamblin Ⅰ CBT, have high sensitivity for Shamblin Ⅱ and high specificity for Shamblin Ⅲ CBT. It plays an important role in diagnosis, perioperative evaluation and follow-up analysis of CBT.
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Affiliation(s)
- Hui Wang
- Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University. Guangzhou, China
| | - Zilun Li
- Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University. Guangzhou, China
| | - Chen Yao
- Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University. Guangzhou, China
| | - Mian Wang
- Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University. Guangzhou, China
| | - Zuojun Hu
- Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University. Guangzhou, China
| | - Ridong Wu
- Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University. Guangzhou, China
| | - Guangqi Chang
- Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University. Guangzhou, China.
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Pordal A, Morin D, Malik R, Reddy P. A Case of Bilateral Carotid Body Tumors. Cureus 2024; 16:e63402. [PMID: 39070388 PMCID: PMC11283869 DOI: 10.7759/cureus.63402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Sporadic bilateral carotid body tumors are a rare paraganglioma of the head and neck that are often asymptomatic and incidentally found during workup for other pathologies. These tumors arise from the chemoreceptor organ located at the carotid bifurcation and can be locally invasive, resulting in the involvement of adjacent neurovascular structures. With the majority of bilateral carotid body tumors having an association with familial syndromes, such as MEN2 or Von Hippel Lindau, the incidence of sporadic bilateral disease is exceedingly rare. In this case report, we report a case of bilateral carotid body tumors in a 54-year-old female with anxiety and tachycardia who underwent MRI and CTA evaluation showing evidence of left greater than right carotid body tumors. The patient was managed operatively in a staged fashion with a resolution of her presenting symptoms and no post-operative morbidity or mortality. Pathologic examination of the bilateral masses confirmed evidence of paraganglioma with immunohistochemical stains showing neoplastic cells positive for synaptophysin, chromogranin, and S100 without lymph node involvement.
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Affiliation(s)
- Angad Pordal
- Department of Surgery, Ascension Providence Hospital, Southfield, USA
| | - Donald Morin
- Department of General Surgery, Ascension Providence Hospital, Southfield, USA
| | - Rema Malik
- Department of Vascular Surgery, Wayne State University Detroit Medical Center, Detroit, USA
| | - Pritham Reddy
- Department of Vascular Surgery, Ascension Providence Hospital, Southfield, USA
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Wardak AF, Ghani T, Ardam SI, Musamim MA, Ghani T, Alamy H. A case report of coexisting multinodular goiter with carotid body tumor. Int J Surg Case Rep 2024; 117:109570. [PMID: 38518471 PMCID: PMC10972836 DOI: 10.1016/j.ijscr.2024.109570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION Carotid body tumor (CBT), a neuroendocrine neoplasm, and benign multinodular goiter (BMNG) are distinct pathologies affecting the neck region. Although rare, they can occur concurrently. This case contributes to the limited evidence regarding the association between these distinct pathologies and their operative management. CASE PRESENTATION The patient was a 45-year-old female with a palpable mass on the right side of her neck. She was diagnosed with Shamblin type III non-secretory CBT alongside BMNG. The surgical intervention included resection of the CBT, carotid artery bypass, and Dunhill thyroidectomy. DISCUSSION This case is the third reported instance of coexisting CBT and BMNG. Their causative relationship is evident in the literature without a clear explanation of the underlying mechanism. Both conditions are treated surgically. Dunhill thyroidectomy for BMNG is a safer option, offering more flexibility and advantages over other thyroidectomies. CONCLUSION This case highlights the complexity of managing such dual pathologies and may provide further evidence of their association.
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Affiliation(s)
| | - Torgot Ghani
- Wazir Mohammad Akbar Khan Hospital, Kabul, Afghanistan.
| | | | | | | | - Haroon Alamy
- Armed Forces science Academy, Kabul, Afghanistan
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Zhiqiang L, Yihua W, Ying F, Shiwei Z, Xiangzhu Z, Ligang C. The value of color doppler ultrasonography combined with computed tomography angiography and magnetic resonance angiography in the preoperative quantification and classification of carotid body tumors: a retrospective analysis. BMC Med Imaging 2024; 24:10. [PMID: 38172706 PMCID: PMC10765896 DOI: 10.1186/s12880-023-01189-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) provide accurate vascular imaging information, but their use may be contraindicated. Color Doppler ultrasonography (CDU) provides simple, safe, noninvasive, and reproducible imaging. We therefore investigated the role of preoperative CDU combined with CTA and MRA in the quantification, typing, and diagnosis of carotid body tumors (CBTs). METHODS We retrospectively analyzed patients with CBTs categorized into group A (type I [n = 1] and type II [n = 10]) or group B (type III [n = 56]) per the intraoperative Shamblin classification. CDU, CTA, and MRA characteristics of CBTs were observed, surgical results were correlated, and the diagnostic threshold of the CBT classification was calculated. RESULTS CBTs were usually located at the common carotid artery bifurcation, encircling the carotid artery. An increased angle was found between the internal and external carotid arteries. On CDU, CBTs primarily presented as homogeneous hypoechoic masses with clear boundaries, rich flow signals, and a high-speed, low-resistance artery-like flow spectrum. CTA showed uniform or heterogeneous marked enhancement. MRA showed mixed T1 and slightly longer T2 signals and uniform or uneven obvious enhancement. With increases in the lesion size, amount of blood transfused, and operation time, the intraoperative classification level and possibility of skull-base invasion increased. When the maximum diameter of the lesion, the volume of the tumor, the distance between the upper margin of the tumor to the mastoid and the mandibular angle were 3.10 cm, 10.15 cm3, - 3.26 cm, and 0.57 cm, respectively, the largest Youden index was the best diagnostic boundary value for Shamblin type III tumors. CONCLUSIONS CDU combined with CTA and MRA can accurately evaluate the size and classification of CBTs.
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Affiliation(s)
- Li Zhiqiang
- Department of Ultrasound Medicine, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, P.R. China.
| | - Wang Yihua
- Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, 73 South Jianshe Rd, Lubei District, Tangshan, 063000, P.R. China
| | - Fu Ying
- Department of Ultrasound Medicine, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, P.R. China
| | - Zhu Shiwei
- Department of Ultrasound Medicine, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, P.R. China
| | - Zeng Xiangzhu
- Department of Radiology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, P.R. China
| | - Cui Ligang
- Department of Ultrasound Medicine, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, P.R. China
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Rahman MA, Venkataram T, Habib R, Jahan N, Raihan F, Alam S, Mahmood E, Umana GE, Chaurasia B. Synchronous Carotid Body and Glomus Jugulare Tumors : A Case Report and Review of Literature. J Korean Neurosurg Soc 2024; 67:122-129. [PMID: 37643721 PMCID: PMC10788546 DOI: 10.3340/jkns.2022.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/27/2023] [Accepted: 04/17/2023] [Indexed: 08/31/2023] Open
Abstract
Paragangliomas are rare neuroendocrine tumors that are usually benign in nature. They may be either familial or sporadic in their occurrence. Numerous neuroendocrine tumors are collectively included under the umbrella of paragangliomas. Among them, carotid body tumors and glomus jugulare tumors are extremely rare. Thus, we present a rare case of 29-year-old male who was admitted with hearing difficulties and tinnitus in the left ear, with swelling on the left side of the neck. Based on clinical and radiological findings, a diagnosis of left-sided glomus jugulare with carotid body tumor was made. The patient underwent a twostage surgery with an interval of approximately 2 months. Histopathology revealed a paraganglioma. Herein, we present the clinical features, imaging findings, management, and a brief review of literature on the classification, evaluation, and management of carotid body and glomus jugulare tumors. Paraganglioma is a slow-growing tumor. The synchronous occurrence of carotid body and glomus jugulare tumors is infrequent. Microsurgical resection remains the primary treatment modality. Therefore, our patient underwent two-stage surgery. The rarity of occurrence and the proximity and adherence to vital neurovascular structures have resulted in the treatment of paragangliomas remaining a challenge.
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Affiliation(s)
- Md Atikur Rahman
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Bangladesh
| | - Tejas Venkataram
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Riad Habib
- Department of Neurosurgery, Enam Medical College, Savar, Bangladesh
| | - Nwoshin Jahan
- Department of Neurosurgery, Combined Military Hospital (CMH), Dhaka, Bangladesh
| | - Farid Raihan
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Bangladesh
| | - Shamsul Alam
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Bangladesh
| | - Ehsan Mahmood
- Department of Neurosurgery, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Gowans C, Treat-Jacobson D. Post-surgical complications of a Shamblin Type II carotid body tumor, a case study. JOURNAL OF VASCULAR NURSING 2023; 41:245-247. [PMID: 38072580 DOI: 10.1016/j.jvn.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Colleen Gowans
- Nurse Practitioner, Vascular Surgery, St. Marks Hospital, Salt Lake City, UT
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10
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Avgerinos N, Avgerinos I, Troupis T, Chrysikos D, Georgopoulos S. Carotid Body Tumor in a 26-Year-Old Male Patient Managed With Preoperative Embolization. Cureus 2023; 15:e49917. [PMID: 38058530 PMCID: PMC10696408 DOI: 10.7759/cureus.49917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
Carotid body tumors are rare, highly vascularized neuroendocrine tumors that arise near the bifurcation of the common carotid artery (CCA). Controversy exists in the management of those tumors about whether preoperative embolization facilitates surgical excision and decreases perioperative complication risk. We present the case of a 26-year-old patient with a carotid body tumor manifesting as a painless pulsatile mass in the anterior triangle over the left side of the neck and provide details of the preoperative diagnostic steps. Treatment included preoperative embolization of the tumor followed by surgical excision after 48 hours to safely address this rare pathology, resulting in a favorable outcome for the patient.
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Affiliation(s)
- Nikolaos Avgerinos
- Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Ilias Avgerinos
- Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Vascular Surgery, Laiko General Hospital of Athens, Athens, GRC
| | - Theodore Troupis
- Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Dimosthenis Chrysikos
- Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Sotirios Georgopoulos
- Vascular Surgery, Laiko General Hospital of Athens, Athens, GRC
- Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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Kihara C, Patel S, Moss R. A Rapidly Progressing Carotid Body Tumor: A Case Report. Cureus 2023; 15:e43654. [PMID: 37719473 PMCID: PMC10505067 DOI: 10.7759/cureus.43654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Carotid body tumors (CBTs) are a rare form of paragangliomas that often arise near the carotid bifurcation. They are typically slow growing and often asymptomatic. We report a case of a CBT in a 70-year-old man, who presented with a firm, painless, pulsatile neck mass that rapidly increased in size over the course of two months. The diagnosis was suspected based on the patient's clinical history and physical examination. The diagnosis was confirmed with CT angiography (CTA). The tumor was nonfunctioning based on normal urinary-free catecholamines, vanillylmandelic acid (VMA), and metanephrines levels. The patient then underwent a CT scan of his thorax, abdomen, and pelvis which did not detect any metastatic spread. The patient was referred to a tertiary vascular surgery center for definitive treatment. Our aim in presenting this case is to increase awareness of this rare type of paraganglioma with the hope of increasing early intervention and improving outcomes.
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Affiliation(s)
- Colby Kihara
- Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | | | - Roger Moss
- Family Medicine, Decatur Morgan Hospital, Decatur, USA
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12
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Alqhtani AJ, Algahtani SM, Alharbi MK, Aljehani MH, Alharbi A. Carotid Body Tumor: A Case Report of a Rare Neuroendocrine Neoplasm. Cureus 2023; 15:e42224. [PMID: 37605682 PMCID: PMC10440150 DOI: 10.7759/cureus.42224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Carotid body tumors are rare neuroendocrine tumors originating from paraganglionic cells in the carotid body. Although these tumors are typically slow-growing and benign, their location and vascularity present unique challenges in management. Here, we present a case study of a 58-year-old male who presented with a painless, gradually enlarging neck mass over a six-month period. Physical examination revealed a non-tender, pulsatile mass measuring approximately 3 cm in the left carotid triangle. Imaging studies, including ultrasound and contrast-enhanced computed tomography, confirmed the presence of a well-defined, hypoechoic mass at the left carotid bifurcation, displacing adjacent vessels. A multidisciplinary team planned surgical resection, guided by imaging, resulting in the successful removal of the tumor. Histopathological examination confirmed the diagnosis of a carotid body tumor. This case report underscores the significance of accurate diagnosis, a multidisciplinary approach, and advanced imaging techniques in managing carotid body tumors. Surgical resection, guided by imaging, aims to achieve complete excision while preserving vital structures. Long-term follow-up is crucial to detect potential recurrence or progression early.
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Affiliation(s)
| | - Samar M Algahtani
- Collage of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | - Ahlam Alharbi
- Family Medicine, Primary Health Care Center, Riyadh, SAU
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13
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Nayak A, Parida PK, Aswathi KV, Preetam C, Pradhan P, Samal DK, Mohanty S, Adhya AK. Carotid Body Tumors: Institutional Experience of 10 Cases and a Review of Literature. Indian J Otolaryngol Head Neck Surg 2023; 75:1282-1289. [PMID: 37275006 PMCID: PMC10234938 DOI: 10.1007/s12070-022-03226-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 09/24/2022] [Indexed: 11/07/2022] Open
Abstract
Carotid body tumors are slow growing neck masses that arise from the neural crest cells at the carotid bifurcation. Majority are asymptomatic and are diagnosed incidentally. Surgical excision is accepted as the treatment of choice to reduce complications. In the present series, we report 10 cases of carotid body tumors and our institutional experience. All patients underwent radiological evaluation with an ultrasonography with Doppler, contrast enhanced computed tomography and MR angiography. 6 cases were operated by a transcervical excision. The tumor was excised in tototranscervically. One of the cases required saphenous vein graft intraoperatively due to vascular injury and also had postoperative vocal cord palsy. The rest had an uneventful recovery. Carotid body tumors although rare and seemingly indolent can cause substantial symptoms if left untreated. A prompt multi modality approach is needed for both diagnosis and treatment to avoid major complications.
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Affiliation(s)
- Anindya Nayak
- Department of ENT and Head-Neck Surgery, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha India
| | - Pradipta Kumar Parida
- Department of ENT and Head-Neck Surgery, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha India
| | - Kallyadan Veetil Aswathi
- Department of ENT and Head-Neck Surgery, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha India
| | - Chapitty Preetam
- Department of ENT and Head-Neck Surgery, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha India
| | - Pradeep Pradhan
- Department of ENT and Head-Neck Surgery, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha India
| | - Dillip Kumar Samal
- Department of ENT and Head-Neck Surgery, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha India
| | - Satyapriya Mohanty
- Department of ENT and Head-Neck Surgery, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha India
| | - Amit Kumar Adhya
- Department of ENT and Head-Neck Surgery, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha India
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14
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Nashnoush M, Lad M, Masood I, Singh A, Sazzad S, Bharmal S, Negussie M, Marwan M, Eskander S. Multiparametric analysis of carotid body tumours: a pictorial essay. J Ultrasound 2023; 26:553-561. [PMID: 36114987 PMCID: PMC10247662 DOI: 10.1007/s40477-022-00711-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Carotid body tumours (CBT), also called carotid body paraganglioma, are highly vascular and histologically portray paraganglion cells. They are typically found at the carotid bifurcation and result in the splaying of the internal and external carotid arteries (ICA and ECA). Recent literature supports the role of chronic hypoxia in the etiology of CBT. This pictorial essay discusses how CBT is an uncommon etiology for common clinical problems such as transient ischemic attacks. It also discusses imaging techniques to precisely map out the tumour for surgical resection using advanced imaging modalities and techniques.
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Affiliation(s)
- Mohamed Nashnoush
- School of Health Sciences, Dalhousie University, 1278 Tower Road, Halifax, NS, B3H 2Y7, Canada.
| | - Mrinal Lad
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Isha Masood
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Arjun Singh
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Sadman Sazzad
- Alumni of Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Sidra Bharmal
- Faculty of Science, University of Western Ontario, London, ON, Canada
| | - Michael Negussie
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Menna Marwan
- Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Sherry Eskander
- Department of Biology, University of Toronto, Toronto, ON, Canada
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15
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Sarafoleanu C, Badea C, Lupoi D. BILATERAL CAROTID BODY PARAGANGLIOMAS - LITERATURE REVIEW AND COMMENTS IN A PATIENT WITH NO SIGNS OF MEN SYNDROME. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2023; 19:133-141. [PMID: 37601710 PMCID: PMC10439330 DOI: 10.4183/aeb.2023.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Paragangliomas are rare neuroendocrine slow-growing tumors, often asymptomatic, that originate from embryonic neural crest cell. In the head and neck area, the most common location is the carotid body, followed, with decreasing frequency, in jugular, tympanic and vagal sites. Bilateral carotid body tumors are extremely rare. Aim To present the most important features of carotid body paragangliomas, illustrating the clinical characteristics, associated with a thorough analysis of the diagnostic imaging elements, but also the current therapeutic strategies, with respective anatomical, surgical considerations and potential complications that can occur. Surgical resection is the main line of treatment. The complex anatomy of the cervical region and the close relationships of carotid body paragangliomas with carotid vessels and cranial nerves, as well as its intense vascularization makes the surgical intervention a real challenge even for an experienced surgeon. Discussion Starts from a bilateral carotid paraganglioma in a 35-year-old male, with painless lateral neck swelling, accidentally discovered by his barber about two years ago. Diagnosis was suspected on the basis of history, clinical and radiological findings. "Wait and scan" strategy plus endocrinologic assessment for MEN syndromes were considered the optimal therapeutic approach in this case.
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Affiliation(s)
- C. Sarafoleanu
- “Sfanta Maria” Clinical Hospital, ENT&HNS Department, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - C. Badea
- “Sfanta Maria” Clinical Hospital, ENT&HNS Department, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - D. Lupoi
- “Sfanta Maria” Clinical Hospital, ENT&HNS Department, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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16
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Gonzalez-Urquijo M, Castro-Varela A, Barrios-Ruiz A, Hinojosa-Gonzalez DE, Salas AKG, Morales EA, González-González M, Fabiani MA. Current trends in carotid body tumors: Comprehensive review. Head Neck 2022; 44:2316-2332. [PMID: 35838064 DOI: 10.1002/hed.27147] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Carotid body tumor (CBT) is a rare neoplasm that has been increasingly studied during the last decades; nevertheless, it continues to be a topic of controversy. This review aims to provide an update on the general features of CBT and particularly review different treatment strategies and primary outcomes. METHODS Data for this literature review were identified by PubMed, Scopus, and Medline. 93 articles from the initial search were included, as well as 28 relevant studies utilizing the snowballing method; totaling 121 articles about CBT. RESULTS Main features such as anatomy, embryology, genetics, clinical presentation, and diagnosis of CBT are presented, followed by evidence of different treatment strategies such as radiotherapy, preoperative embolization, vascular resection, and vascular reconstruction. Main complications are also discussed. CONCLUSION This review summarizes the most critical aspects regarding CBT. Future studies should compare different treatments to attain the best surgical results with lower morbidity rates.
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Affiliation(s)
| | - Alejandra Castro-Varela
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Alanna Barrios-Ruiz
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | | | - Ana Karen Garza Salas
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Erick Ambriz Morales
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Mirna González-González
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico.,Tecnologico de Monterrey, The Institute for Obesity Research, Monterrey, Nuevo León, Mexico
| | - Mario Alejandro Fabiani
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
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17
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吕 海, 李 谱, 张 名, 曹 连, 王 振. [A case of cervical lymph node metastasis after carotid body tumor surgery]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:475-476. [PMID: 35822369 PMCID: PMC10128488 DOI: 10.13201/j.issn.2096-7993.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Indexed: 06/15/2023]
Abstract
Malignant carotid body tumor is rare, reported this case who had experienced the totally resection of carotid body tumor 16 years ago and presented with cervical tumor now. The patient was a 68 year old male who presented with a low growing left-sided painless neck mass for half a year. Carotid body tumor resection and left carotid artery artificial vascular reconstruction were performed 16 years ago. Physical examination showed that multiple hard and painless masses can be touched behind the left sternocleidomastoid muscle of the neck. Blood routine and biochemical tests were normal. MRI enhancement of the neck showed multiple circular abnormal signals behind the left sternocleidomastoid muscle, with obvious enhancement. The cervical masses of this case were experienced totally resected again, and the postoperative pathology confirmed that it was carotid body tumor and cervical lymph node metastasis. The clinical diagnosis was malignant carotid body tumor with cervical lymph node metastasis. Postoperative PET-CT examination showed multiple lymphadenopathy and abnormal metabolism in hilar, mediastinum and abdominal aorta. Multiple systemic metastasis of malignant carotid body tumor was considered. It was suggested that preoperative whole-body PET-CT examination can be used to evaluate whether the tumor has systemic metastasis.
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Affiliation(s)
- 海丽 吕
- 首都医科大学宣武医院耳鼻咽喉头颈外科(北京,100053)Department of Otolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - 谱 李
- 首都医科大学宣武医院耳鼻咽喉头颈外科(北京,100053)Department of Otolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - 名霞 张
- 首都医科大学宣武医院耳鼻咽喉头颈外科(北京,100053)Department of Otolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - 连杰 曹
- 首都医科大学宣武医院耳鼻咽喉头颈外科(北京,100053)Department of Otolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - 振霖 王
- 首都医科大学宣武医院耳鼻咽喉头颈外科(北京,100053)Department of Otolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
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18
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López-Arcas JM, Colmenero CM, Martínez R, Martín-Hernán F, Ruiz-Sánchez B, Aragoneses JM. Giant carotid chemodectoma treated with a combination of surgery and CyberKnife radiotherapy: a case report and review of the literature. J Med Case Rep 2022; 16:92. [PMID: 35216640 PMCID: PMC8876796 DOI: 10.1186/s13256-021-03237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/19/2021] [Indexed: 11/22/2022] Open
Abstract
Background Paragangliomas are rare vascular neuroendocrine tumors that develop in the extra-adrenal paraganglion tissue. They occur most commonly at the carotid bifurcation, where they are known as carotid body tumors. Most paragangliomas are benign, locally aggressive, infiltrative tumors. Approximately 10% of patients with paragangliomas develop distant metastases, 10% present with multiple or bilateral tumors (mostly carotid body tumors), and 10% have a family history of paragangliomas. The malignant transformation of carotid body tumors has been reported in 6% of cases.
Case presentation We present the case of a 64 year-old Caucasian woman with a gigantic glomic tumor mass in the neck. Twenty years before the consultation, the patient had undergone an unsuccessful attempt to remove the mass. Over the last 3 years, the patient had felt enlargement of the mass at an increased rate, almost doubling the prior size. Angio magnetic resonance imaging showed a 9 cm paratracheal mass on the left cervical side that laterally displaced the sternocleidomastoid muscle and 2 c m of the trachea. Due to the change in the tumor behavior, the maxillofacial team at Ruber International Hospital decided to remove the tumor surgically after embolization. During the surgery the tumor was gently dissected from the carotid an removed from the carotid bifurcation uneventfully. Two small nodes adhering tightly to the internal carotid adventitia and the posterior torn hole were left in place to avoid any potentially life-threatening complications. The final biopsy confirmed the initial diagnosis of carotid body paraganglioma and showed a Ki-67 expression of 19%. Due to the aggressive growth behavior and high Ki-67 expression of the tumor, the patient was referred to the CyberKnife Unit of Ruber International Hospital for treatment of the remaining nodes. Conclusions The management of cervical paragangliomas is difficult and remains a challenge. Although the likelihood of tumor control is high with surgical or radiotherapeutic treatments, we currently lack consensus regarding the best treatment option. Nevertheless, in selected complex cases, such as the case we present, the combination of surgery and radiosurgery may allow complete local tumor control with minimal morbidity.
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Affiliation(s)
- José M López-Arcas
- Oral and Maxillofacial Surgeon. University Hospital Infanta Leonor, Madrid, Spain
| | - César M Colmenero
- Head of the Craniofacial and Maxillofacial Unit, Ruber International Hospital, Madrid, Spain
| | - Roberto Martínez
- Chief Cyberknife Radiosurgery Unit. Hospital Ruber Internacional, Madrid, Spain
| | | | | | - Juan Manuel Aragoneses
- Department of Dental Research, Federico Henriquez y Carvajal University, Santo Domingo, 10106, Dominican Republic
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Bhattacharjee S, Jain RD, Bathala L, Hk A, Sharma VK. Pictorial Essay of Cervical Duplex Ultrasonography. POCUS JOURNAL 2022; 7:245-252. [PMID: 36896382 PMCID: PMC9983729 DOI: 10.24908/pocus.v7i2.15635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objectives: Cervical duplex ultrasonography (CDU) is a simple, non-invasive, portable technique, that provides valuable high-quality visual information about the integrity of the carotid and vertebral vessels, plaque morphology and flow hemodynamics. CDU is useful in the assessment and follow up of patients with cerebrovascular disease as well as other conditions like inflammatory vasculitis, carotid artery dissection and carotid body tumours. CDU is inexpensive and invaluable in smaller centres. Methods: CDU was performed in all patients in both longitudinal and transverse planes in the out-patient clinic. Brightness mode (B-mode) and Doppler waveforms were obtained. Relevant findings were presented. Results: CDU provides real time visualisation of plaque characteristics and follow up, hemodynamic characteristics in Takayasu arteritis, visualisation of dissection. Conclusion: With availability of MR/CT angiography, CDU can be an adjuvant in follow up, triage and early bed-side diagnosis of the vascular diseases. We present our experience with CDU in the out-patient clinics in this pictorial essay.
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Affiliation(s)
| | | | | | | | - Vijay K Sharma
- Division of Neurology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital Singapore
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20
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Liu J, Mu H, Zhang W. Diagnosis and treatment of carotid body tumors. Am J Transl Res 2021; 13:14121-14132. [PMID: 35035757 PMCID: PMC8748146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/27/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To investigate the clinical diagnosis, treatment, and complication prevention of carotid body tumors (CBTs). METHODS The medical records of 24 patients with CBTs treated in the Department of Oral and Maxillofacial Surgery in Shandong Provincial Hospital Affiliated to Shandong First Medical University from 1999 to 2014 were reviewed. All the patients had unilateral CBTs and underwent preoperative B-mode ultrasound. Before surgery, CBT diagnosis was confirmed by digital subtraction angiography (DSA) in 8 patients, magnetic resonance imaging (MRI) in 9 patients, and computed tomography angiography (CTA) in 11 patients. All the patients had surgical intervention and preoperative Matas test. The retrograde stump pressure in the internal carotid artery was monitored in all the cases during surgery. Transcranial Doppler (TCD) inspection was performed on all patients before and during surgery. Simple tumor resection was performed in 8 patients, and excision of both the tumor and external carotid artery was performed in 11 cases. Five patients received intraluminal shunt after tumor resection and partial removal of internal, external, and common carotid arteries. RESULTS The diagnostic accuracy of B-mode ultrasound, DSA, MRI, and CTA was 75%, 100%, 88.9%, and 90.9%, respectively. In the enrolled 24 patients, tumors were completely removed with no postoperative death, hemiplegia, or blindness. There were 4 cases of transient hypoglossal nerve palsy and 1 case of transient vagus nerve involvement after surgery, which were recovered after 4-8 months of follow-up. No recurrence was found in the included patients during the followed-up, varied from 3 months to 4 years. B-mode ultrasound examination can be used as a preliminary screening method. DSA, CTA, and MRI are all effective diagnostic tools for CBTs. Among them, the diagnostic coincidence rate of DSA is 100%, making it the most effective means of inspection. Surgical resection is the first choice for the treatment of CBT patients who are willing to undergo surgery. CONCLUSIONS Preoperative routine Matas test can improve the brain tolerance of patients with carotid artery occlusion, preoperative, and intraoperative TCD monitoring are beneficial to understand the intracranial circulation in the circle of Willis. Intraoperative monitoring of residual arterial pressure and intraluminal shunt can prevent or significantly reduce the incidence of serious postoperative complications.
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Affiliation(s)
- Junjie Liu
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021, Shandong, China
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong UniversityJinan 250021, Shandong, China
| | - Hong Mu
- Department of Otorhinolaryngology, Qi Lu Children’s Hospital of Shandong UniversityJinan 250022, Shandong, China
| | - Weidong Zhang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021, Shandong, China
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