Glomus Jugulare tumor (a.k.a. chemodectoma or nonchromaffin
CECT demonstrates a destructive, enhancing mass centered in the
right jugular foramen.
Coronal T1W post contrast MRI confirms these findings and
demonstrates a characteristic "salt and pepper" appearance to the
Right external carotid artery angiogram shows a large,
hypervascular tumor fed by the right occipital, ascending
pharyngeal, and posterior auricular arteries with evidence of
This patient was status post embolization and resection of a
previous right glomus jugalare tumor one year prior this
presentation and returned to clinical attention due to recurrent
hearing loss and tinnitus, a common presentation of these tumors.
Other presenting symptoms include hearing loss, nerve palsies,
arrythmias, and flunctuating blood pressure.
Glomus Jugulare tumors arise from paraganglionic cells
associated with the vagus nerve in the jugular bulb, are slow
growing, and can erode bone, as in this case. Vascular encasement
of invasion can also be seen. The tumor tends to spread by the
"path of least resistance"-inferiorly along the post-styloid
parapharyngeal space and superiorly into the posterior cranial
fossa-and roughly 10% are multiple at presentation. Angiography is
the standard of case, to evaluate blood supply to the tumor and in
some cases to offer preoperative embolization.
The differential for a hypervascular erosive jugular foramen
mass also includes: meningioma, hemangiopericytoma, metastasis
(such as from kidney or thyroid), angiofibroma, granular cell
tumor, endolymphatic sac tumor, and plasmacytoma. While
nasopharyngeal masses and schwannomas may grow into the jugular
foramen, these are not typically hypervascular.
Radiology Clinics of North America, September 2000, 1059-76 Case
Review: Head and Neck Imaging. Yousem.