Presentation
Painless left cervical mass, progressively increasing in size with left vocal cord palsy.
Patient Data
Age: 55 years
Gender: Female
From the case:
Vagal and recurrent nerve schwannoma
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There is a well-circumscribed heterogeneous hypoechoic left cervical mass, highly vascularised on colour/power Doppler.
From the case:
Vagal and recurrent nerve schwannoma
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The CT scan demonstrates:
- Vividly enhancing left cervical mass measuring closely adherent to the vagus and recurrent laryngeal nerves, displacing the internal and common carotid arteries anteromedially, the internal jugular vein anterolaterally then passes anterior to the left subclavian artery and lateral to the aortic arch
-
Signs of left vocal cord palsy:
- enlarged left pyriform sinus
- thickened with the medial position of the aryepiglottic fold
- medial rotation of the left arytenoid cartilage
- dilated left laryngeal ventricle "sail sign"
Case Discussion
The location and CT features are suggestive of a vagal and recurrent nerve schwannoma.
On imaging, the main differential diagnosis includes:
- sympathetic chain schwannoma: which displace the ICA and IJV in the same direction
- carotid body tumour: splaying the carotid vessels (lyre sign)
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