SAT-284 - An Unconventional Presentation of A Neuroendocrine Tumor in A Cardiovascular Setting: A Case of A Carotid Body Tumor

Carotid body tumors, colloquially known as glomus tumors, are benign neoplasms derived from embryonic neural crest cells. These rare paragangliomas arise at the bifurcation of the carotid artery and can cause systemic endocrine disturbances such as palpitations, sweating, headaches, and tremors. In addition, local invasion of the tumor can lead to mass effect symptoms and cause patients to experience profound discomfort necessitating medical evaluation.

A sixty-eight-year-old male presented to the clinic with a chief complaint of chronic bilateral neck pain radiating down towards his shoulders. He also reported related symptoms including daily heart palpitations alongside a “fluttering” sensation, described in the bronchial region. Additionally, the patient denied symptoms of chest pain, dizziness, syncope, seizures, anxiety, diarrhea, dysphagia or skin discoloration. The patient also reported a past medical history of hyperlipidemia, hypertension, and atrial fibrillation. Due to this patient’s presenting symptoms and his past medical history, a full cardiac workup was completed at the emergency department. A carotid artery ultrasound was performed to assess for atherosclerotic and cardiovascular related disease processes that might have been the source of the chronic pain the patient was experiencing. Sonographic imaging revealed a mass, identified as a benign carotid body tumor with vascular flow. The size of the lesion measured 2.92x2.26x3.35cm, and the mass effect of this tumor likely contributed towards the neuropathic pain the patient reported.

Due to the sensitive location of the neoplasm, surgical consultation may be recommended if future complications related to the compressive nature of the growth arise. Tumors of this size and location require continuous monitoring with yearly carotid ultrasound imaging as implemented in this treatment plan.

This case highlights the importance of a strategic and comprehensive clinical workup. This patient’s symptoms could have been dismissed as an underlying cardiovascular etiology, however a detailed evaluation revealed a neuroendocrine mass. Without proper investigation into presenting symptoms, this glomus tumor could have otherwise been left undiagnosed and consequently mismanaged. Carotid body tumors have potential to progress to devastating outcomes if not addressed appropriately, therefore it is critical to recognize and explore various pathologies to avoid premature and misleading diagnoses.

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