Arteriographic Discovery of a Small Contralateral Carotid Body Tumor

Carotid body tumors, uncommonly encountered at the bifurcation of the common carotid artery, represent neoplastic degeneration of normal chemoreceptor cells. They occur in all age groups but are most commonly diagnosed during the third and fourth decades. The patients are usually asymptomatic except for a palpable mass in the neck, although large tumors may produce dysphagia, hoarseness, or local pain. On physical examination, the mass shows free lateral movement but is restricted vertically. There may be a bruit or a transmitted pulsation. The tumors are generally benign. Although 7 per cent of the cases are said to be malignant, half of these metastasized only locally (2, 3, 6). There is a significant hereditary tendency, and 26 per cent of the patients with a positive family history have bilateral disease, compared with 2.8 per cent in nonfamilial tumors (6). Since Idbohrn first demonstrated a carotid body tumor arteriographically (5), there have been numerous successful reports. Desai and Patel reviewed the subject and reported 2 familial bilateral tumors (1). Hawkins reviewed the arteriographic findings in 5 cases (4). Gehweiler and Bender recently reviewed the literature while reporting 3 additional cases (3). The demonstration of a coarsely vascular, well-demarcated mass at the carotid bifurcation is diagnostic of this tumor. The carotid body tumors reported thus far have been discovered by inspection or palpation of the neck and hence have been relatively large. At operation, such tumors are intimately adherent to the carotid artery, and removal has required dissection in a plane deep to the adventitia of that vessel. This report describes a case with a positive family history, in which a small unsuspected tumor was found on the contralateral side during the course of arteriography on a clinically apparent tumor. This small tumor was excised with such ease that we recommend bilateral examinations of all patients in this clinical setting. Case History R. S., a 24-year-old Caucasian male, was admitted to the Surgery Branch of the National Cancer Institute with a left neck mass having the clinical characteristics of a carotid body tumor. The mass was discovered four years prior to admission on routine physical examination and had gradually enlarged during this interim. Other than local discomfort on palpation, the patient had no symptoms referable to the mass. The family history is pertinent in that a diagnosis of carotid body tumor had been made in 4 paternal relatives. Physical examination revealed a firm, smooth, mildly tender 6 × 8 cm ovoid mass situated in the left mid-neck, deep to the sternocleidomastoid muscle. The mass was freely movable in a horizontal plane but could not be displaced vertically. There was no audible bruit. Bilateral transfemoral carotid arteriography was performed. Examination of the left side demonstrated a typical, coarsely vascular mass at the carotid bifurcation (Fig. 1).