Intratumoral pseudoaneurysm in a carotid body tumor.

Background: The occurrence of secondary vascular pathology in paragangliomas is extremely rare, particularly in carotid body tumors (CBTs).

Case description: A 73-year-old female presented with computed tomography angiography revealing a right CBT with a large intratumoral contrast collection. Digital subtraction angiography confirmed a CBT with an internal carotid artery (ICA) intratumoral pseudoaneurysm. Interventional neuroradiology performed coil embolization of the pseudoaneurysm, and a covered stent was placed in the ICA. Surgical intervention was deferred, and the patient was closely monitored with Doppler ultrasound.

Conclusion: Diagnostic imaging is crucial in the management of CBT, offering detailed assessment of tumor morphology and their anatomical relationships, particularly in identifying coexisting vascular anomalies. Recognition of vascular pathologies, such as intratumoral pseudoaneurysms, is critical, as failure to do so could lead to life-threatening complications, including severe bleeding during surgical resection. In cases where surgical resection is high risk due to tumor classification or patient comorbidities, palliative endovascular treatment presents a viable alternative. This approach not only reduces tumor vascularity and provides symptomatic relief but also minimizes procedural risks. While surgical resection remains the gold standard for complete tumor removal, embolization serves as an option in complex or inoperable cases and may also be used to reduce intraoperative risks when surgery is feasible.