case_images: PMC11772210_01
case_images: (A) and (B) are axial noncontrast CT of head and neck with a coronal reformat, respectively, showing an expansile soft tissue density well-marginated mass (white star) in the left parotid region, which is nondestructive to the adjacent bone and does not breach the skin. It measures 5.75 x 4.59 x 2.81 cm. Red arrows show blood vessels.
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case_images: PMC11772210_01_CCR3-13-e70155-g004.jpg
case_images: ccr370155-fig-0001
case_images: The imaging revealed a mass, measuring 5.75 x 4.59 x 2.81 cm, which appeared as an expansile, well-marginated soft tissue density within the left parotid region (Figure 1), with no destruction of adjacent bone structures and no skin breach. Notably, a prominent feeding artery and draining vein were observed (Figure 1), indicative of a high blood flow within the lesion.
case_images: (A) and (B) are contrasted head and neck CT coronal reformats with the mass showing avid enhancement in the arterial phase, with retention of contrast in the venous phase, respectively. This makes this mass (red star) an arteriovenous malformation.
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case_images: PMC11772210_01_CCR3-13-e70155-g002.jpg
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case_images: The imaging also showed a hypervascular mass in the left parotid region, which exhibited early and intense contrast enhancement in the arterial phase (Figure 2).
case_images: A maximum intensity projection of the head and neck vessels showing a mixed density mass in the left parotid region, with a nodular, tortuosity of the intertwining arteries and veins giving it the characteristic "bag of worms" appearance. A feeding vessel, which is the left posterior auricular artery, is noted branching into the mass, with another feeder seen from the left subclavian artery. There are multiple draining veins noted with some separated into a hypoplastic and inferiorly duplicated left external jugular.
case_images: CCR3-13-e70155-g003.jpg
case_images: PMC11772210_01_CCR3-13-e70155-g003.jpg
case_images: ccr370155-fig-0003
case_images: Additionally, MIP imaging highlighted the intricate vascular network, revealing a tortuous collection of intertwining arteries and veins, giving the mass a "bag of worms" appearance typical of AVM (Figure 3). The primary feeding vessels, originating from the left posterior auricular artery and left subclavian artery, supplied the mass, with multiple draining veins observed, including a hypoplastic and inferiorly duplicated left external jugular vein (Figure 3).
case_images: (A) and (B) are 3D reconstructions, posterior and anterior views, respectively. These show multiple intertwining vessels (white star) in the left parotid region of the patient, with a similar appearance to both arteries and veins.
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case_images: Three-dimensional reconstructions further detailed the arrangement of these vessels, showing the distinctive intertwining structure of arteries and veins in the parotid region (Figure 4).