Case of Incidental Asymptomatic Carotid Body Paraganglioma in a Patient with Infectious Mononucleosis

Abstract

A paraganglioma is a rare form of neuroendocrine tumor of neural crest cell origin. These tumors arise from autonomic ganglia, and are classified based on their origin in the autonomic nervous system, with sympathetic paragangliomas being more commonly located in the abdomen and parasympathetic paragangliomas more commonly found in the head and neck region. Paragangliomas have a characteristically slow growth rate, and while many will present due to symptoms of mass effect or from hyper functional catecholamine secretion, some tumors are diagnosed incidentally on imaging studies. In this report, we present the case of a 33-year-old man who presented to the emergency department with symptoms of infectious mononucleosis and recurrent tonsillitis, for which he was scheduled to have a tonsillectomy in the near future, but was incidentally found on a CT scan of the neck to have an asymptomatic carotid body paraganglioma. Due to the close anatomical relationship between the carotid artery and tonsillar bed, had this surgery occurred without first discovering the paraganglioma it may have placed the patient at increased risk for a disastrous intraoperative hemorrhage. This idea prompts otolaryngologists to consider how best to approach the diagnosis of paragangliomas in patients that have yet to become symptomatic.