Asian Journal of Case Reports in Surgery

Lipomas are the most common benign mesenchymal tumors and typically arise in areas where fat is naturally present. However, their occurrence in the head and neck region is uncommon in all age groups. Here, we present a rare case of a carotid sheath lipoma in a 64 year old female. The patient presented with a firm non-tender, multinodular thyroid swelling with noticeable fullness in the right cervical region. Ultrasonography suggested a TIRADS IV lesion in the left lobe thyroid, and a few solid cystic lesions in the right lobe of the thyroid. CECT imaging revealed a large mass with homogenous fat attenuation in the right parapharyngeal space laterally displacing the internal carotid artery and protruding into the pharynx consistent with a lipoma with a multinodular goiter. Total thyroidectomy with surgical enucleation was performed by incising the carotid sheath while preserving the vital structures. Histopathological examination confirmed the diagnosis of lipoma. Carotid sheath lipoma is extremely rare and can pose as a diagnostic challenge due to their location near vital structures and association with multinodular goiter. Accurate imaging and timely diagnosis are important for the management.