Carotid Encasement from Metastatic Neuroblastoma
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This was a patient who had metastatic neuroblastoma
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with skull-based metastases.
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We're starting in this neck
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CT scan at the skull base.
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So you can see the involvement of the craniofacial
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region for which the patient had surgery.
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You can see that the ethmoid sinus has been
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operated on as well and the diffuse surgery
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of the nasal septum, etc.
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However, the patient appeared to have metastatic disease in
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the retropharyngeal and carotid space region on the
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right side. So let's look on the left side,
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the internal carotid artery and the jugular vein,
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in the poststyloid parapharyngeal space,
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the carotid space. However,
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on the right side we have this enhancing tissue
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which is encasing the internal carotid artery.
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So if we look for our internal carotid
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artery at the carotid bifurcation,
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we can see that there is diffuse involvement of the
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internal carotid artery on the right side with
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encasement by tumor that is enhancing.
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And in fact,
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we don't see the lumen of the internal carotid
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artery as it is encased by the tumor.
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If we continue up superiorly,
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we can see that the carotid artery does reconstitute
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at the petrous internal carotid artery.
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So let's follow again the distal cervical internal
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carotid artery here being encased
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by this enhancing tumor.
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So the 360 degrees of involvement of this carotid
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artery by metastatic neuroblastoma suggests that indeed
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this is encased and not surgically resectable.
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And this is one of the examples of nodal metastases
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that can lead to carotid encasement.
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So you may have primary tumors of the systems
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such as the hypopharynx or esophagus that was
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described as well as lymph node metastases which
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cause encasement and non-salvageable internal
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carotid artery in this case.
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
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