29year old woman w/ ~15 year history of a small lateral painless neck mass. She presents now with 1 month persistent hoarse voice following laryngitis. Pt is an avid amateur singer and is concerned that her ‘breathy hoarse’ voice has not resolved. Pt reports history of painless left lateral neck mass since a teenager; was told by PCM it was a ‘lymph node’. Pt denies mass changing in size or any other issues/complaints. ROS: Denies fever, chills, decreased neck ROM. Denies neck pain, tenderness, dysphagia, odynophagia, or feeling of neck fullness. PMH: Asthma, GERD, Nephrolithiasis during pregnancy, snoring d/t deviated septum. PSH: Lithotripsy, Septoturbinoplasty. No complications. Meds: albuterol prn, flovent prn, omeprazole SH: Full-time homemaker. Married for 6 years. Denies alcohol, smoking, or illicit drug use. FH: Mother and maternal grandmother had migraines and breast cancer. Father had occupational hearing loss and DM2. Examination:: VS:HR76, BP 117/67, RR18, O2Sats: 98% on Room Air. BMI 24.3 HEENT: Atraumatic Normocephalic, pupils anicteric equally round reactive to light and accomadation. External Auditory Canals clear bilaterally, TMs clear and mobile. Pink moist mucous membranes. Firm mobile mass in left lateral neck, measuring ~3 cm by palpation without bruit, freely moves horizontally, vertical movement restricted, no palpable LAD, thyroid normal. CT & Angiogram Done. Need expert opinion on the case. Please help here


Intensely enhancing mass splaying left ECA & ICA...Carotid body tumour (paraganglioma)

Slow growing, non tender, with restricted vertical mobility. CT & Angio suggestive of arising between Internal & external carotids with Splaying- Lyre's sign. D/D- Carotid body tumour Glomus Jugulare Shwannoma Lymphnode mass. (Unlikely) Inv- MRI for typical appearance on T1 & T2 weighted images, for differentiation between the lesions. FNAC & Biopsy better to be "Avoided".

tumor splaying the internal and external carotids at the bifurcation.

Differntils: Congenital: Branchial Cleft Cyst Inflammatory: Reactive lymphadenopathy, Abscess Neoplastic: Lymphoma, Salivary Gland Tumors, Neurogenic tumors, Paraganglioma Vascular: Aneurysms of the carotid artery, Hematoma, Pseudoaneurysm

Carotid body tumor,excision is the treatment of choice