slide1
Download
Skip this Video
Download Presentation
Wednesday January 26, 2011

Loading in 2 Seconds...

play fullscreen
1 / 27

Wednesday January 26, 2011 - PowerPoint PPT Presentation


  • 137 Views
  • Uploaded on

Wednesday January 26, 2011. Duplex Assessment of Carotid Body Tumor. Presented by Linda Silorey and Lonni Bhirdo. Carotid Body- Anatomy. Ovoid, red/brown to tan organ Outer adventitia layer Posterior-medial wall of bifurcation of CCA

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Wednesday January 26, 2011' - haruki


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
duplex assessment of carotid body tumor

Duplex Assessment of Carotid Body Tumor

Presented by Linda Silorey and Lonni Bhirdo

slide3

Carotid Body- Anatomy

  • Ovoid, red/brown

to tan organ

  • Outer adventitia layer
  • Posterior-medial wall of

bifurcation of CCA

  • 3-5 mm in size ~ larger in people in higher altitudes
  • Receives blood supply from branches of the ECA

Linda Silorey and Lonni Bhirdo

slide4

Carotid Body- Function

  • Regulates Autonomic Nervous System
  • Chemoreceptor sensitive to

changes of arterial O2 , CO2

and pH changes

  • Sensitive to changes in BP,

blood flow, & blood osmolarity (salt content)

  • Sends signals to the brain

that result in changes in

respiratory rate/cardiac output

  • Factors such as Increased temperature of blood, Cyanide and nicotine cause stimulation of the Carotid Body

Linda Silorey and Lonni Bhirdo

carotid body tumor
Carotid Body Tumor

aka CBT

  • Arises from the normal tissue of the carotid body between the ECA/ICA
  • Lateral pulsatile neck mass- often presenting with a bruit or thrill
  • A rare highly vascular

tumor - incidence of only 0.01%

  • Usually benign
  • Most often fed by ECA branch:

Ascending Pharyngeal Artery

  • Other terms used to describe CBTs:

Chemodectomas, endothelioma glomus caroticum, peritheliomas and paragangliomas

Linda Silorey and Lonni Bhirdo

slide6

CBT- Etiology/ Incidence

  • Over- response to homeostasis changes
  • Hypertrophy linked to

hypoxia/ hypercapnia

  • Higher Altitudes, Smoking, COPD
  • Genetic 10 % of cases
  • 45-50 years of age
  • Female - rare in children
  • South American
  • Bilateral in 5% of cases

Linda Silorey and Lonni Bhirdo

cbt signs symptoms
CBT- Signs & Symptoms

Other Systemic Symptoms

Suggesting More Advanced

Disease Include:

Malaise

Weight Loss

Fatigue

Tachycardia

Linda Silorey and Lonni Bhirdo

cbt diagnostic tests
CBT-Diagnostic Tests
  • DuplexUltrasound
  • MRA
  • CTA
  • Angiography

Linda Silorey and Lonni Bhirdo

slide9

Duplex Ultrasound

  • Often the examination of choice for Dx of CBT: Readily available,
  • painless, non-invasive, relatively risk free and takes less than
  • an hour
  • Always do a complete bilateral Carotid study to identify for

Stenosis as well as to rule out a contralateral tumor

  • Machine settings and focal zones should be optimized to visualize the superficial nature of the Carotid arteries- these settings also make it possible to visualize CBTs.
  • Three modalities are used for diagnostic information:

B-Mode or grayscale, Color flow, Doppler Spectral analysis

Linda Silorey and Lonni Bhirdo

slide10

Duplex Ultrasound: B-Mode

B-Mode/ Grayscale Helps:

  • Identify location, internal echo pattern and shape

of any incidental finding of a neck mass

  • Differentiate whether the mass is solid or cystic

If mass is in fact at the bifurcation

  • Whether splaying of the ICA/ ECA is a CBT

or instead Aneurysmal Disease

or Carotid Artery kinking

  • CBTs are solitary masses with hypoechoic,

homogeneous or heterogeneous echo patterns

  • Margins of CBTs are well defined and smooth

Linda Silorey and Lonni Bhirdo

slide11

Duplex Ultrasound: B-Mode

  • Provides anatomical “road map”

of Carotid Artery

  • Image in both transverse and

longitudinal scanning planes

  • Splaying of ICA and ECA is one of primary

ultrasound findings in Dx of CBT

  • Measure in both Trans (AP & LAT)

and Sagittal (long) for image length

Linda Silorey and Lonni Bhirdo

slide12

SPLAYED BIFURCATION

Normal Carotid Bifurcation (Sag)

Carotid Body Tumor

Linda Silorey and Lonni Bhirdo

slide13

Duplex Ultrasound: Color Flow

  • Second to splaying, Color Flow

Characteristics is a very valuable

diagnostic tool in the Dx of CBT

  • Color Flow identifies blood

flow within a tumor- a key

feature of CBT

ICA

  • Helps identify between nonvascular,

hypovascular and hypervascularity of

blood flow within a tumor

ECA

  • Allows for differentiation between

CBT and other incidental findings

such as lymph nodes, salivary gland

tumors and metastatic neck masses

Linda Silorey and Lonni Bhirdo

slide14

Duplex Ultrasound: Doppler

  • To further differentiate a CBT from other tumors,
  • Doppler is used to assess the spectral waveforms
  • of the arteries within and feeding the CBT
  • Waveforms are most commonly Low-Resistant within
  • the tumor and feeding vessels
  • There is also usually increased Diastolic Flow in the ECA
  • artery branch feeding the tumor

Linda Silorey and Lonni Bhirdo

slide15

Reporting of CBT

  • CBT is only one of many types of masses that can be found when performing a Carotid Duplex examination
  • Other findings include: Enlarged Lymph Nodes

Metastatic Lesions

Thyroid or Parathyroid Masses

Lipomas

Salivary Gland Tumors

Tumors of Nerve Sheath (Schwannoma)

    • Important to note location of mass in relation to surrounding landmarks/structures
    • Measurements listed in three planes: AP, Lat and Sag
    • Description of mass: round, oval, lobular
    • Margin or Boarders: well defined, poorly visualized, diffused, regular, irregular
    • Echo Patterns (compared to surrounding tissue): Hypo/Hyperechoic
    • Color Flow Patterns: Flow vs No Flow visualized

Linda Silorey and Lonni Bhirdo

treatment
Treatment
  • The tumor is classified via the Shamblin

classification- which is based on the tumor’s

involvement of the ICA

  • Usually slow growing, surgical resection is the

most common treatment due to invasive nature

of CBTs. They are often found wrapped around

the ICA and ECA, can erode into the base of skull

and can entrap regional cranial nerves

  • Feeding vessels are often embolized 1-2 days prior to

resection to reduce tumor size, ease the resection

and reduce intraoperative blood loss

  • The ECA is sometimes sacrificed to control bleeding

and improve access to the ICA. Immediate repair or

replacement of the CCA and or ICA may be needed

Linda Silorey and Lonni Bhirdo

slide24

CBT- Prognosis

  • Post surgery stroke

and cranialnerveinjury

risk was 35%

  • 3-9 % mortality rate
  • Incompleteexcision has

overallrecurrence rate of

10-15%

  • Significant increase in mortality rate with CarotidArteryligation

Linda Silorey and Lonni Bhirdo

slide25

Special Thanks

to

Macomb Surgical Associates!!!

Linda Silorey and Lonni Bhirdo

slide26

References

Linda Silorey and Lonni Bhirdo

slide27

References- cont.

Picture Sites

http://medical-dictionary.thefreedictionary.com/carotid+body

http://www.cvrx.com/patients/index.php?id=41

http://www.cvrx.com/patients/index.php?id=41

http://www.radrounds.com/photo/carotid-body-tumor-64row-mdct?context=user

http://www.imagingeconomics.com/issues/articles/MI_2006-01_10.asp

http://wjso.com/content/3/1/10

http://www.daviddarling.info/encyclopedia/C/carotid_ultrasound.html

http://oto.sagepub.com/content/118/1/82.abstract

http://www.vascularweb.org/APDVS/Pages/CerebrovascularModule.aspx

http://www.centrus.com.br/DiplomaFMF/SeriesFMF/18-23-weeks/chapter- 13/sga_01.html

http://www.healthcaremagic.com/healthpage/branchial-cyst

Linda Silorey and Lonni Bhirdo

ad