Brief anatomic review- CS extends Carotid Space PathologyBrief anatomic review- CS extends from...
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Carotid Space Pathology REBECCA S CORNELIUS, MD, FACR PROFESSOR OF RADIOLOGY AND OTOLARYNGOLOGY UNIVERSITY OF CINCINNATI MEDICAL CENTER Brief anatomic review- CS extends from skull base to aortic arch Carotid sheath surrounds the carotid space and is composed of all 3 layers of deep cervical fascia Suprahyoid carotid space ICA IJV CN 9-12 Infrahyoid carotid space CCA IJV CN 10 Pathologic processes in carotid space Neoplastic Vascular Infectious/Inflammatory Pseudomass Asymmetric IJV Ectatic/tortuous carotid artery Benign neoplasm Paraganglioma Schwannoma Neurofibroma Meningioma Paraganglioma/ glomus tumor Arise from paraganglia/glomus bodies – chemoreceptor cells derived from neural crest tissue Common locations: Tympanicum & jugulare- along nerves of Jacobson & Arnold at level of middle ear and jugular foramen Vagale- nodose ganglion just below the skull base Carotid body- at carotid bifurcation
Transcript of Brief anatomic review- CS extends Carotid Space PathologyBrief anatomic review- CS extends from...
Carotid Space Pathology
REBECCA S CORNELIUS, MD, FACR
PROFESSOR OF RADIOLOGY AND OTOLARYNGOLOGY
UNIVERSITY OF CINCINNATI MEDICAL CENTER
Brief anatomic review- CS extends from skull base to aortic arch Carotid sheath surrounds the carotid space and is composed of all 3 layers of deep cervical fascia
Suprahyoid carotid space
ICA
IJV
CN 9-12
Infrahyoid carotid space
CCA
IJV
CN 10
Pathologic processes in carotid space
Neoplastic
Vascular
Infectious/Inflammatory
Pseudomass
Asymmetric IJV
Ectatic/tortuous carotid artery
Benign neoplasm
Paraganglioma
Schwannoma
Neurofibroma
Meningioma
Paraganglioma/ glomus tumor
Arise from paraganglia/glomus bodies – chemoreceptor cells derived from neural crest tissue
Common locations:
Tympanicum & jugulare- along nerves of Jacobson & Arnold at level of middle ear and jugular foramen
Vagale- nodose ganglion just below the skull base
Carotid body- at carotid bifurcation
Paraganglioma/ glomus tumor
Rarely hormonally active
Sporadic
Familial
Multicentric
5-20% sporadic
25-50% familial
Multiple gene mutations have been identified in both familial & sporadic types
Associated syndromes
Paraganglioma syndromes
MEN-2
VHL
Glomus jugulare
Glomus jugulare-CN IX-XII
Glomus vagale Carotid body tumor
Vagal schwannoma
Malignant neoplasm
Direct extension from adjacent space
Nodal metastasis
Lymphoma
ECS of nodal disease to carotid space
SCCA nodal met with ECS
Carotid sheath tumor recurrence
Medullary Thyroid Ca Vascular pathology
Carotid thrombosis/dissection
Pseudoaneurysm
Fibromuscular dysplasia (FMD)
IJV thrombosis
Dissection
Traumatic carotid dissection Carotid dissection
Skiing injury- carotid dissection
FMD with pseudoaneurysm
Carotid blowout IJV thrombophlebitis from line placement
Bilateral IJV thrombosis Retropharyngeal fluid w IJVT
IJV thrombosis Infectious/inflammatory pathology
Cellulitis
Abscess
Suppurative lymphadenopathy
Carotidynia
Oropharyngeal SCCA with fistula and infection
Carotidynia
Pulsatile neck mass
Tenderness to palpation
Circumferential thickening of carotid wall
Enhancing tissue visible on MRI
Symptoms typically resolve after course of anti-inflammatory meds
Carotidynia
Courtesy of Dr. Doug Phillips
Carotidynia
Courtesy of Dr. Debbie Shatzkes
Summary:
Limited differential for pathology arising in the carotid space, based on anatomic contents
Malignancy involving the carotid space occurs via direct extension from an adjacent primary tumor or ECS from malignant lymphadenopathy
