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)