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The wedged position of scalenus anterior between the carotid sheath and the brachial plexus/scalenus medius will also make differentiating between scalenus anterior and these structures difficult.
In the current case, the infiltrative nature of this mass along the carotid sheath suggested an extranodal process but revealed no additional specific findings.
The fistulous tract ascends along the carotid sheath, then posterior to the common carotid artery, then superior to the superior laryngeal, hypoglossal, and vagus nerves; it finally opens into the piriform sinus.
1-3) To our knowledge, no solitary fibrous tumor arising in the carotid sheath has been reported until now.
It also extended medially into the parapharyngeal space anterior to the carotid sheath (figure 1, C).
The sternocleidomastoid muscle was then retracted laterally, exposing the carotid sheath.
Computed tomography of the brain and neck demonstrated a large retropharyngeal abscess, an abscess in the left parapharyngeal space, and a small collection adjacent to the right carotid sheath at the level of C4; the cervical vertebrae and lungs were normal.
MRI demonstrated a left supraglottic mass, as well as a tumor in the left carotid sheath, which had possibly arisen from the left vagus nerve.