Abstract / Summary
INTRODUCTION: Cervical paragangliomas, particularly carotid body tumors, are rare neuroendocrine tumors originating from paraganglionic cells, with a low incidence in the general population. Although they are frequently benign, they have metastatic potential and variable behavior. Evaluation using imaging methods, especially Doppler ultrasonography, plays a fundamental role in diagnosis, surgical planning, and risk assessment. OBJECTIVES: To describe the clinical and imaging characteristics of a carotid paraganglioma evaluated by Doppler ultrasonography, reinforcing its relevance for early diagnosis, therapeutic planning, and a multidisciplinary approach. CASE REPORT: A 66-year-old female patient presented with a slowly growing left cervical mass for approximately 17 years, associated with pulsatile tinnitus, headache, and hoarseness. Ultrasonographic examination revealed a solid, heterogeneous lesion located at the carotid bifurcation, with intense vascularization, a low-resistance pattern, and the classic “lyre sign.” Shamblin II classification was established, indicating partial involvement of the carotid arteries. Additionally, angiography confirmed high peripheral vascularization and hypovascular areas suggestive of fibrosis or tissue remodeling. The ultrasonographic findings correlated with the literature, allowing a strong diagnostic suspicion before the surgical procedure. DISCUSSION: Ultrasonographic evaluation proved to be an essential tool for detecting and characterizing the paraganglioma, identifying its location, vascularization, and relationship with nearby vascular structures. Findings such as the “lyre sign” and the low-resistance pattern on spectral Doppler are classic and facilitate diagnostic suspicion. The Shamblin classification contributes to estimating surgical complexity and the risk of complications. The combination of ultrasound, angiography, and other complementary imaging methods is crucial for safe management, particularly in longstanding tumors, which may present areas of fibrosis or necrosis due to their gradual expansion. CONCLUSION: Doppler ultrasonography is a valuable tool in the investigation of carotid paragangliomas, enabling early diagnosis, detailed morphological and hemodynamic assessment, and assistance in surgical planning. Its characteristic findings, together with the Shamblin classification, reinforce the importance of an effective multidisciplinary approach, contributing to better clinical outcomes in these complex and rare tumors.