0:01

This was an individual with a left

0:03

sided enlarging mass in the neck.

0:06

And as we come up to the region of the hyoid bone,

0:11

we can see that this is not a subtle finding.

0:14

Here we have a large mass which is deep

0:18

to the sternocleidomastoid muscle.

0:20

If we follow this blood vessel,

0:22

we note that this is the common

0:24

carotid artery.

0:26

And then the carotid bifurcation

0:28

is located way up here.

0:30

So what to do about this mass?

0:33

Well, it does seem to be encapsulated.

0:37

It is intermediate in signal intensity

0:39

without big flow voids within it.

0:42

How about the displacement of the blood vessels?

0:45

So we notice that the common carotid artery

0:48

was displaced anteriorly.

0:49

Here's the common carotid artery here

0:53

displaced anteriorly.

0:55

Where is the jugular vein?

0:59

So we have to go low down in the neck to find the jugular vein.

1:04

Here we can see the subclavian

1:06

vein joining with the

1:09

jugular vein. And we see that the jugular vein,

1:14

as we follow it upward,

1:16

is being displaced anteriorly by this mass.

1:20

It is compressed.

1:22

So here's a small jugular vein right here,

1:26

and then it's anteriorly displaced by the mass.

1:32

The anterior displacement of

1:34

the common carotid artery

1:36

and the jugular vein argues in favor of a

1:40

sympathetic nervous system neurogenic tumor.

1:44

Now, I am saying neurogenic tumor

1:47

deliberately in this case.

1:50

The reason why I'm saying it is because there is

1:53

a component here of a central dark signal and

1:57

a peripheral bright signal associated

2:00

with this mass,

2:01

which might suggest that this

2:02

represents a neurofibroma.

2:05

So, could this be a neurofibroma of the

2:08

sympathetic nervous system? Well,

2:11

there are some other hints on this study which you

2:14

may have seen as I was scrolling

2:16

through the images,

2:18

and that includes this lesion right

2:20

here on post contrast scanning,

2:23

which is associated with a nerve root

2:26

in the lower cervical spine.

2:29

And you see here marked enlargement of the neural

2:35

foramen at another level of the cervical

2:38

spine on the right side.

2:40

This is coming out here from the neural foramen.

2:44

So this is a patient who has

2:46

multiple neurogenic tumors.

2:48

Notice on the left side,

2:50

a posterior rootlet showing contrast enhancement, as well.

2:55

And here is another one in the soft tissues

2:57

showing contrast enhancement.

3:00

This is an individual who has neurofibromatosis

3:03

with multiple neurogenic tumors,

3:06

and I would argue a good example, potentially,

3:11

of a patient who has a target sign,

3:14

dark center,

3:15

bright peripheral of a neurofibroma affecting the

3:20

sympathetic nervous system on the left side,

3:23

displacing both common carotid artery,

3:25

as well as internal jugular vein anteriorly.