Paraganglioma

Paraganglioma Radiology

Fig. 13.28a A strongly contrast-enhancing mass in the left carotid bifurcation is visible in this axial MRI section of the tongue base. b Selective angiography with the catheter tip in the left common carotid artery documents several well-vascularized

Skull Base Tumors

tumors at the bifurcation and the skull base. c After emboliza-tion with small particles via a branch of the external carotid artery, the vascular blush is gone and chances for a safer and effective curative surgical procedure are greatly improved.

Fig. 13.28a A strongly contrast-enhancing mass in the left carotid bifurcation is visible in this axial MRI section of the tongue base. b Selective angiography with the catheter tip in the left common carotid artery documents several well-vascularized tumors at the bifurcation and the skull base. c After emboliza-tion with small particles via a branch of the external carotid artery, the vascular blush is gone and chances for a safer and effective curative surgical procedure are greatly improved.

portions of the sympathetic nervous system. They can arise at different levels along the cervical vascular bundle. In Mr. Mascarpone's case a paraganglioma of the carotid bulb would need to be considered. Cervical paraganglio-mas are typically located at the carotid bifurcation and enhance intensely after contrast administration (Fig. 13.28a). Because the lesion is very vascular, a preoperative embo-lization via the branches of the external carotid artery is often requested by the surgeons (Fig. 13.28b, c).

Arteriovenous fistula: Aneurysms or an arteriovenous fistula can also cause a pulsatile mass or bruit anywhere in the body. If the fistula has a large caliber, the arteriovenous shunt volume may induce high-output cardiac failure. The documentation of an arteriovenous fistula (Fig. 13.29a, b) and frequently also its therapy—embolization with balloons or metallic coils (Fig. 13.29c)—is performed by the radiologist.

• Diagnosis: Joey and Paul have made up their minds. This is definitely a lateral cervical cyst in a typical location. The patient is visibly relieved by the good news. His sedation makes it necessary to keep him in the unit him for a little while before his driver can take him back to the Park Hyatt in his turbo-charged Humvee. The head and neck surgeons will take care of him in due course.

I Arteriovenous Fistula

I Arteriovenous Fistula

Brachiocephalic Fistula

Fig. 13.29a Angiography with the catheter tip in the brachiocephalic artery illustrates the immediate venous shunting into the azygos vein system (at the orifice into the vena cava, the contrasts medium is diluted). The first segment of the vertebral artery is significantly dilated by the increased blood flow; its caliber resembles that of a large carotid artery. b Selective angiography using an individually angulated projection and with a catheter in the vertebral artery orifice depicts the arteriovenous fistula to its best advantage. The vessel running cranially is the normal segment of the vertebral artery. c After embolization of the fistula with metallic coils, normal anatomical blood flow is restored.

Fig. 13.29a Angiography with the catheter tip in the brachiocephalic artery illustrates the immediate venous shunting into the azygos vein system (at the orifice into the vena cava, the contrasts medium is diluted). The first segment of the vertebral artery is significantly dilated by the increased blood flow; its caliber resembles that of a large carotid artery. b Selective angiography using an individually angulated projection and with a catheter in the vertebral artery orifice depicts the arteriovenous fistula to its best advantage. The vessel running cranially is the normal segment of the vertebral artery. c After embolization of the fistula with metallic coils, normal anatomical blood flow is restored.

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