Doppler ultrasound appearance of neck tumors

Abstract

Aim: The purpose of this study was the evaluation of the sonographic appearance of neck tumors and determining the features useful in differential diagnosis. Material and method: The studied group consisted of 57 patients: 16 patients with carotid body tumors, 9 patients with neurogenic tumors, 8 patients with venous anomalies, 12 patients with neck cysts, 6 patients with lipomas, 5 patients with extracranial carotid artery aneurysms and 1 with a laryngocele. Results: All carotid paragangliomas were located within the carotid bifurcation and demonstrated rich low-resistance vascular flow, with higher maximum velocity and lower flow resistance parameters registered in the ipsilateral external carotid artery. In 7 out of 9 cases, neurogenic tumors were homogeneous, and in the remaining 2 cases – heterogeneous. Four schwannomas were hypervascular or showed moderate vascularity, and the rest of neurogenic tumors were hypovascular or avascular, with symmetrical maximum velocity and resistance values of carotid blood flow. Apart from one branchial cleft cyst with multiple fine internal acoustic reflexes, all other neck cysts were anechoic and avascular, and presented with posterior acoustic enhancement. The laryngocele presented as a well-demarcated, hypoechoic, homogeneous lesion located in the immediate proximity of the larynx, without signs of internal vascular flow. Lipomas were well-demarcated, homogeneous, hypoechoic tumors with regular margins, without signs of internal vascular flow. Venous malformations presented as irregular, hypoechoic spaces with venous blood flow, easily compressed by the probe. Extracranial carotid artery aneurysms were hypoechoic, well-defined spaces, which presented with slow internal, turbulent flow on Doppler study, and showed continuity with the carotid artery. Conclusions: Doppler ultrasound allows to visualize features characteristic for certain neck tumors. Solid or cystic structure, echogenicity, localization, as well as internal flow signals and vascularity pattern create a combination of ultrasound findings helpful in the differential diagnosis of lesions such as paragangliomas, venous malformations, neurogenic tumors, aneurysms, cysts and laryngoceles.

Contrast Enhanced Vascular Imaging Used in the Diagnosis of a Carotid Body Tumor: A Case Report

“…As they enlarge, they may cause symptoms due to local compression of the adjacent structures, causing dysphagia, hoarseness of voice, or symptoms related to crania nerve or sympathetic neuropathies. 1,5 Most paragangliomas appear to be benign, but over time about 5% of these tumors may display malignant behavior, mostly spreading to the adjacent and/or metastatic lymph nodes. 6,7 Due to the high vascularity and potentially catecholamine secreting nature of these tumors, fine needle aspiration biopsy is relatively contraindicated.…”

“…Causes of localized neck swelling may include but are not limited to enlarged lymph nodes due to lymphadenopathy, thyroid disease, metastatic lesions, thyroglossal duct cysts, brachial cleft cysts, laryngocele, lipomas, and extracranial carotid artery aneurysms. 5,8 As carotid body tumors are highly vascular in about 80% of the cases described in the literature, contrast enhancement ultrasound (CEUS) using Definity was used to provide a confirmatory diagnosis of vascularity. This allowed for the staff to appropriately triage and refer the patient to vascular surgery for further medical management.…”

New Insights into Cervicofacial Vascular Anomalies

“…Imaging investigations for these combined malformations range from ultrasound with color Doppler to CT and MRI and angiography. The diagnostic and therapeutic approach to all aspects of pathology is necessary [ 62 , 63 ].…”

Tumor Temperature: Friend or Foe of Virus-Based Cancer Immunotherapy

“…Although not a direct measure of core tumor temperature, these findings raise the possibility of reduced temperatures for soft tissue tumors. Shimatani et al proposed that poor tumor blood flow may be one of the factors contributing to the lower temperatures they identified, based on a previous study demonstrating that lipoma tumors have lower internal vascular flow [ 6 , 37 ]. These studies support the role of reduced vasculature, metabolism, and the presence of tumor necrosis in determining lower tumor temperatures.…”