Volume 49, Issue 3 Fall 2025 JVU 493-145 | Bilateral Carotid Body Tumor-Bilateral Carotid Body Tumor

Bilateral Carotid Body Tumor

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This case report documents a rare instance of bilateral carotid body tumors (paragangliomas) in a 72-year-old female presenting with occipital headaches and bilateral neck pain. Carotid body tumors are neuroendocrine neoplasms arising from parasympathetic or sympathetic ganglia located at the adventitial layer of the distal common carotid artery (CCA) flow divider. These tumors are typically benign, slow-growing, and can remain painless lateral masses on the neck; however, 6% to 19% may metastasize. The etiology includes idiopathic, familial, and genetic causes.<br /><br />Initial computed tomography (CT) scans revealed heterogeneous enhancing lesions at the carotid bifurcations with vascular splaying, suggesting paragangliomas. Subsequent duplex ultrasound (DUS) confirmed solid vascular masses anterior to the internal carotid artery (ICA) and posterior to the external carotid artery (ECA) bilaterally, without significant arterial stenosis or compression. Magnetic resonance angiography (MRA) corroborated the presence of bilateral carotid body tumors, with the right lesion more prominent.<br /><br />Paragangliomas receive blood supply mainly via the ECA, and tumor growth widens the ICA-ECA space. Tumors are classified into three types based on size and vessel involvement; this patient had type 1 tumors, which are small and minimally attached. High-altitude residents, such as the patient from Ecuador, have an increased risk, possibly linked to hypoxia-induced carotid artery hypoplasia. Familial cases, accounting for 10-30%, often present bilaterally.<br /><br />Endocrine evaluation to rule out hormonal secretion is essential. Management typically favors conservative surveillance unless tumors exhibit rapid growth, malignancy, or hormonal secretion, warranting surgical resection, sometimes guided by positron emission tomography (PET).<br /><br />The report underscores the importance for sonographers to recognize carotid body tumors during carotid artery imaging to enable early detection, accurate diagnosis, and appropriate management, improving clinical outcomes.

Keywords

bilateral carotid body tumors

paragangliomas

occipital headaches

neck pain

carotid bifurcation

computed tomography

duplex ultrasound

magnetic resonance angiography

endocrine evaluation

surgical resection