Ultrasonography, Doppler

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Incidental Diagnosis of Carotid Body Paraganglioma

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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Original Article

Carotid Evaluation in Patients with Suspected Coronary Disease: Is There a Negative Prediction?

José Luiz Fernandes Molina Filho et al. Francisco das Chagas Lima e Silva

Abstract

Introduction

Due to its prevalence and gravity, coronary diseases require a more definite and early sort of diagnosis. Thus, there is extreme urgency in identifying patients under the risk of such problem. The most important indicator of risk is a previous manifestation of atherosclerosis itself. In this context, the study of subclinical atherosclerosis may bring to light essential information.

Objective

To evaluate if there is any connection between carotid and coronary alterations; if the absence of atherosclerosis in the arterial bed may indicate absence of obstructive atherosclerotic disease in the coronary bed; and if the absence of carotid lesion might substantiate the non indication of coronarography, keeping in mind the clinical characteristics of each patient.

Methods

This study was observational, transversal, analytic and comparative. Fifty consecutive patients were included, having clinical indication for coronarography. A vascular ultrasound exam of the carotids was performed for a comparison of the results.

Results

All patients with no carotid plaque, evaluated using vascular ultrasound, did not present any significant coronary obstruction, as evaluated via coronarography. All patients who showed significant carotid obstruction, ≥ 50%, also presented significant coronary obstruction, ≥ 70%. Among the evaluated points, only the result of the vascular ultrasound exam of the carotids was seen as a risk predictor in the findings obtained via vascular ultrasound (odds ratio of 2,58; confidence interval 1,66-4,02; p < 0,001).

Conclusion

There was a positive association between the degree of the atherosclerotic lesion of the carotid and of the coronary. No patient without carotid lesion showed significant obstruction of coronary artery, presenting high negative predictive value.