Paragangliomas are rare benign neuroendocrine tumors of extra-adrenal location, but a small proportion may have a clinical malignant behavior and metastasize. In the neck, they usually affect the carotid body and are inactive in the secretion of catecholamines. These tumors are often asymptomatic but may present as a pulsatile cervical mass or cause compression in adjacent structures. Surgical excision is the only potentially curative treatment since histological evaluations may be limited to provide a definitive diagnosis of malignancy. Late recurrence can occur. Here we present the case of a 56-year-old asymptomatic woman who underwent carotid ultrasound to screen for atherosclerotic disease in whom a vascularized well-defined hypoechoic mass was incidentally noted in the carotid bifurcation (). Contrast computed tomography confirmed findings compatible with paraganglioma (). The patient underwent surgery and the diagnosis was confirmed.

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