Paragangliomas are rare hypervascularized tumors, arising from chromaffin cells which derive from neuroendocrine cells originating from the neural crest. These cells are involved in the production, storage, metabolism and secretion of catecholamines. There is a strong affinity of catecholamines for chromium salts; thus these cells turn brown in their presence, hence their name chromaffins. These cells can be located outside the adrenal medulla at the level of structures belonging to the para- and orthosympathetic system. Paragangliomas are rare tumors; they represent 0.03% of all neoplasias and 0.6% of head and neck .tumors carotid paragangliomas represent (60-70%) paragangliomas of the head and neck Familial forms account for 10% of cases [11,12]. Lesions are bilateral in 40% of cases [11]. Multiple localizations of paragangliomas are found in about 4% of sporadic forms and 30% of hereditary forms, or approximately 20% for all forms combined. There is a predominance of females in most of the series, the sex ratio Female to Male is very variable from one series to another .The very vascular and locally invasive nature of carotid paragangliomas is the cause of clinical symptoms which develop insidiously and depend on the volume of the tumor. A large number of paragangliomas are initially asymptomatic and slow growing. Clinical manifestations are most often linked to the anatomical location of the tumors, by irritation or compression of adjacent structures. The most described are pulsatile tinnitus, cervical swelling, paralysis of certain cranial nerves and hypoacusis. They are sometimes associated with signs of hypersecretion of catecholamine with high blood pressure, and paroxysmal episodes of headache, sweating and palpitations. Several differential diagnoses must be ruled out when faced with a lateralized neck mass, including lymphoma, carotid aneurysm, metastatic lymphadenopathy, thyroid lesion, sublingual gland tumor and “Brachial cleft cysts”. The ultrasound appearance of carotid paragangliomas is that of a heterogeneous, hypoechoic mass located in the carotid bifurcation [7,16,17]. Differential ultrasound diagnosis with other cervical tumors, particularly certain highly vascular lymphadenopathies, can be difficult. It is therefore an examination which allows a certaine orientation. Any vascularized cervical tumor on ultrasound should be evaluated by other imaging examinations. The CT scan provides information on the vascular nature of the tumor, its location, its relationship with neighboring elements as well as possible intracranial infiltration and the presence of a contralateral paraganglioma [16]. It ensures precise analysis of the tumor by defining morphological and topographical characteristics [2,9]. The paraganglioma appears as a homogeneous tissue mass, with clear contours, of average tissue density. During iodine injection, the contrast is rapid, intense and fleeting due to vascular washing phenomena. The distinction of the carotid vessels can be difficult when they are encompassed by a corpuscular tumor [7,9] Concerning MRI angiography, it is the examination of choice and gives a precise evaluation of the locoregional extension and a analysis of the Willis polygon by making cuts in the three planes of space in the event that clamping or ligation of the caortid would be necessary, the diagnosis can be made in the face of hypervascularization of the tumors thanks to angiography sequences in multiplanar sectionsand we find a signal T1 iso to hypointense compared to muscle salt and pepper appearance when larger, representing a combination of punctate regions of hemorrhage or slow flow (salt) and flow voids (pepper)  and intense enhancement following gadolinium. T2 hyperintense compared to muscle salt and pepper appearance.The sensitivity of this examination is 90% (12), which allows better detection than angio-CT. On the other hand, this examination is less effective in describing bone damage and hypotympanic lesions. The therapeutic attitude seems to be unequivocal, both in surgical resection and However, radiotherapy can be recommended preoperatively for large tumors or to treat metastases and tumor recurrences.In 1991 Shamblin et al introduced a classification based on tumor size to codify therapeutic conduct. Thus, these tumors are subdivided into three classes:

• Class I corresponds to a small tumor allowing excision outside the carotid vessels;
• Class II includes medium-sized tumors with close vascular relationships requiring subadventitial dissection;
• Finally, class III where the tumor is large and closely linked to the vascular axis requiring resection or replacement of the internal and or external carotid artery.