Question

How will you evaluate a person suspected of CBT?

Hint:

Imaging, particularly CT or MRI angiography, is essential for determining the exact location and vascularity of the CBT, which guides treatment planning.

Answer 1

Step 1: Clinical Examination:
The first step in evaluation is a thorough history and physical examination. Patients may present with a palpable mass in the neck, hoarseness, difficulty swallowing, or a pulsatile mass. A careful examination of the neck should be performed to assess the size, consistency, and mobility of the mass.
Step 2: Imaging Studies:
Imaging plays a pivotal role in the diagnosis of CBT. The following imaging techniques are essential: - Ultrasound: A Doppler ultrasound is commonly the first imaging modality used. It helps assess the vascular nature of the mass and can detect characteristic features such as a hypervascular tumour. - CT Angiography (CTA): CTA provides detailed images of the carotid artery and surrounding structures. It helps assess the size of the tumour and its relationship with the carotid artery, jugular vein, and cranial nerves. - MRI: MRI is helpful for detailed soft tissue imaging and can provide additional information on tumour location and its relationship to adjacent structures.
Step 3: Angiography:
In some cases, conventional angiography is performed to visualize the tumour’s blood supply and assess its vascularity. This is particularly helpful when planning surgical resection.
Step 4: Biopsy:
If the imaging findings are inconclusive, a biopsy may be performed to confirm the diagnosis. Fine needle aspiration (FNA) is often used, but care must be taken to avoid complications such as bleeding or tumour spillage.