Overview
Clinical Orientation
A slowly enlarging, painless mass at the side of the neck may be a carotid body paraganglioma: a rare, highly vascular tumour growing beside the carotid bifurcation.
A slowly enlarging, painless mass at the side of the neck may be a carotid body paraganglioma: a rare, highly vascular tumour growing beside the carotid bifurcation. The experienced nurse notices two risks immediately. First, the mass may encase or displace the carotid arteries and lower cranial nerves. Second, although most head and neck paragangliomas do not secrete catecholamines, a functional tumour can produce abrupt hypertension, tachycardia and dysrhythmia, especially when stimulated. The first clinical question is therefore not simply, What is this neck mass? It is, Could this be a hypervascular paraganglioma, and could it be catecholamine-producing? That question determines whether biopsy is unsafe, which tests come first and whether alpha-adrenoceptor blockade is needed before an operation.