Case Report Lyre sign – Where schwannoma mimics a carotid body tumour

Fatin N. Sahar, Hilwati Hashim, Norliana D. Mohamad Ali, Masaany Mansor, Yin P. Wong

South African Journal of Radiology | Vol 29, No 1 | a3072 | DOI: https://doi.org/10.4102/sajr.v29i1.3072 | © 2025 Fatin N. Sahar, Hilwati Hashim, Norliana D. Mohamad Ali, Masaany Mansor, Yin P. Wong | This work is licensed under CC Attribution 4.0
Submitted: 09 November 2024 | Published: 29 April 2025

About the author(s) Fatin N. Sahar, Department of Radiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
Hilwati Hashim, Department of Radiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
Norliana D. Mohamad Ali, Department of Radiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
Masaany Mansor, Department of Otorhinolaryngology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
Yin P. Wong, Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

Abstract

Nerve sheath tumours arising from the sympathetic chain are extremely rare and present a diagnostic challenge. We report the case of a 31-year-old man who presented with an asymptomatic right cervical swelling. He was evaluated with sonography, CT, MR and angiography. Surgical excision of the lesion was performed, and histological examination revealed a schwannoma. The differential diagnosis of such tumours and their management are discussed. Imaging features of carotid body tumours and parapharyngeal schwannomas can be similar, as both can cause splaying of the carotid bifurcation, resulting in the lyre sign. This is illustrated by the case of a 42-year-old female who presented with a left neck swelling. Tumour was surgically excised, and histologic examination confirmed a schwannoma.

Contribution: This article highlights another cause of the lyre sign besides carotid body tumours and their relationship to carotid bifurcation on radiological imaging.

Keywords

schwannoma; neck neoplasms; magnetic resonance imaging; carotid body tumor; parapharyngeal neoplasms

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