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This was an interesting case in

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the way that it was found.

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This was a patient who was being evaluated through

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the emergency room for an acute stroke,

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and the patient had ordered a brain MRI,

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brain MRA and neck MRA, with and without contrast.

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This is the raw data from the neck MRA.

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And what you see is the carotid bifurcation

0:28

here on the left side.

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And they were looking for carotid stenosis.

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Didn't see any carotid stenosis.

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But fortunately,

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the person reading it noticed that there seemed to

0:40

be a mass here at the carotid bifurcation in this

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patient who did not have a history of a neck mass.

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And when they were doing the post-contrast neck

0:55

MRA for carotid stenosis, once again,

0:59

no stenosis at the carotid bifurcation.

1:02

But this area of unusual gadolinium enhancement at

1:09

the carotid bifurcation led the individual to

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suggest that maybe there was a carotid body tumor

1:15

there that may be causing the splaying of the

1:19

internal and external carotid artery.

1:21

You may notice as well that it looks like there's

1:24

a little something something

1:26

also on the right side.

1:28

And if I show you the venous phase of the MRA,

1:34

you again seem to pick up that there is something

1:38

enhancing at the carotid bifurcation.

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And maybe, right here, another little oval lesion,

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smaller in size on the contralateral side,

1:49

which in retrospect is this little nodule right

1:54

here, projecting immediately from

1:56

the carotid bifurcation.

1:58

So this was followed with a CT of the neck.

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Here is the CT of the neck

2:05

on that same individual.

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So now we're not in a CTA mode or MRA mode.

2:12

We're looking at this with soft tissue mode.

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And what you can see is the

2:17

contrast-enhancing mass,

2:19

again splaying the internal and

2:21

the external carotid artery,

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extending down a little bit onto the common

2:27

carotid artery and not completely encompassing

2:32

the internal carotid artery as far as its

2:35

circumferential spread. Look on the right side.

2:38

So that lesion that we were fearful of

2:41

is showing contrast enhancement,

2:43

again associated more with the external carotid

2:45

artery than the internal carotid artery,

2:47

but at the carotid bifurcation.

2:49

So this is an example of a patient who

2:51

has bilateral carotid body tumors.

2:55

And we'll talk about the various familial

2:57

syndromes in which this is a risk factor.