Vascular Tumor in the neck

      A

This 31 year old female health care worker presented to her family  physician with a  painless mass on the (R) side of her neck.This prompted an immediate  ulltasound  and duplex  of the area  which showed a  vascular mass with both arterial and venous flow( A ) The work up also included investigation of the thyroid gland which was negative.From the ultrasound it was difficult to determine whether this lesion was in the external jugular vein or intimately involved with compression.
   
  A MRI was done of the neck to include axial T1,T2 views, coronal T1and T2 as well as vascular sequencing. ( B ).The test  demonstrated  a 3x1 cm. mass anterior and medial to the sternocleidomastoid muscle in the area of the jugular vein.The differential at this point was that of a hemangioma or perivascular soft tissue tumor and  angiography was recommended.

  A carotid angiogram was done ( C  )  and demonstrated an oval shaped enhancing  mass anterior to the common carotid artery at the level of the larynx with a strong angiographic blush fed by branches of the superior thyroid artery.A small draining vein was also seen (D ).

The patient was subsequently taken to the operating room where the mass was found to originate in and distort the external jugular vein.Several large and small venous branches to the tumor were identified and ligated as well as  the superior thyroid artery,The lesion  was opened proir to being sent down to pathology and simply looked  like a gelatinous "glob". The intial diagnosis was that of a hemangiopericytoma but when referenced out the final diagnosis was  returned as a
INTRAVENOUS  PYOGENIC GRANULOMA

   This lesion usuall presents as a reddish/brown imtravascular polyp and looks very much like a thrombus.It arises from the vein wall and is attached by a stalk with a feeder vessel.This lesion is benign and usually does not have an inflammatory component. There  is likely a female predeliction.Most small series descibe these lesions  in the head/neck area.

      
In the differential diagnosis are various forms of lobular capillary  hemangiomas, intravascular papillary endothelial hyperplasia and  acquired  immune deficiency vascular tumors

     B

    C

   D