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Ruth L. Bush, MD; Alan B. Lumsden, MD; Peter H. Lin, MD
[+] Author Affiliations

From the Division of Vascular Surgery, Joseph B. Whitehead Department of Surgery, and the Department of Interventional Radiology, Emory University School of Medicine and the Emory University Hospital, Atlanta, Ga.


Section Editor: S. Rozycki Grace, MD


Arch Surg. 2001;136(9):1085. doi:.
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A HEALTHY 73-year-old woman was seen for a slowly enlarging right cervical mass located near the angle of her mandible. She had symptoms of fever, chills, and hoarseness. Physical examination demonstrated a firm, nontender, pulsatile mass without associated lymphadenopathy. A bruit was present over the mass on auscultation. A computed tomography scan was performed, showing a 3 × 2-cm mass located between the external and internal carotid arteries (ICA) that enhanced with intravenous contrast injection (Figure 1). The mass was partially wrapped around the ICA. There was no evidence of invasion into the surrounding tissues, nor was there a mass in the contralateral neck. A cerebral arteriogram showed "splaying" of the external carotid artery and the ICA, with blushing seen on delayed images (Figure 2).

WHAT IS THE MOST APPROPRIATE MANAGEMENT FOR THIS PATIENT?

A. Angiographic embolization of blood supply to the mass

B. Surgical resection of the mass

C. External beam radiation

D. Close observation with repeated computed tomography or magnetic resonance scans

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