Fig 2. MRI Base of skull to root of neck (a)T2 WI showing a lobulated heterogeneously hyperintense lesion in left parotid gland with internal flow voids suggestive of internal vessels, (b)T1WI post contrast, showing significant post contrast enhancement
CT angiography of neck revealed possibilities of a neoplasm with high vascularity- high flow vascular malformation. It was diagnosed as a case of left parapharyngeal arterio- venous malformation, a plan of excision of tumor with prior embolization was made. Digital subtraction angiography (DSA) showed hyper vascular tumor pattern in left parotid region with predominant supply from hypertrophied right ECA branch (posterior auricular artery) with minor supply from few twigs of facial artery and no supply from right vertebral artery noted.
Patient underwent pre surgical embolization by contralateral approach-right femoral artery. Particle embolization done with 300- 500 micro and 500-700 micro PVA particles and posterior auricular artery was blocked. Check angiography revealed >90% reduction in tumor blush. (Fig 3a, 3b)