# Multifocal Head and Neck Paragangliomas: A Case Report of Bilateral Carotid Body Tumors With DOTANOC-Avid Thyroid Lesion

## TL;DR

This case report describes a rare instance of a 32-year-old man with bilateral carotid body tumors and a thyroid lesion, highlighting the role of imaging and the need for genetic evaluation.

## Contribution

The novelty lies in the rare presentation of bilateral carotid body tumors with a DOTANOC-avid thyroid lesion and the emphasis on imaging and genetic evaluation.

## Key findings

- Multimodality imaging confirmed hypervascular lesions with carotid artery splaying and vascular encasement.
- Histopathology confirmed the diagnosis of paraganglioma in the reported case.
- The case underscores the importance of genetic evaluation in multifocal paraganglioma presentations.

## Abstract

Carotid body tumors (CBTs) are rare neuroendocrine neoplasms arising from paraganglionic tissue at the carotid bifurcation. Bilateral and multifocal involvement is uncommon and may indicate an underlying hereditary predisposition. We report a case of a 32-year-old man who presented with bilateral neck swellings and was diagnosed with bilateral CBTs and a DOTANOC-avid thyroid nodule. Multimodality imaging, including CT angiography and Ga-68 DOTANOC PET/CT, demonstrated hypervascular lesions with characteristic carotid artery splaying and variable degrees of vascular encasement. Imaging played a crucial role in lesion characterization, assessment of tumor extent, detection of multifocal disease, and surgical planning. Histopathological evaluation confirmed the diagnosis of paraganglioma. This case highlights the importance of comprehensive imaging evaluation in patients with suspected paragangliomas and emphasizes the need to consider genetic evaluation and long-term surveillance in multifocal presentations.