A 61-year-old man with alcoholic cirrhosis, hepatocellular carcinoma, and a smoking history presented with 3 months of blurred vision, periorbital headache and 10-pound weight loss. On exam, he had left-sided ptosis, miosis (Fig. 1) and diminished sensation in the left ophthalmic trigeminal nerve distribution. Computed tomography (CT) revealed a 1.5 × 2.0 × 3.0 cm parapharyngeal mass encasing the left internal carotid artery (ICA) with significant narrowing; however, no dissection (Fig. 2). A CT-guided biopsy showed inflammation and no malignant cells. Aspirate cultures were negative. The etiology was inconclusive, but strongly favored malignancy.
Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.