This is an axial computed tomography (CT) scan and an axial magnetic resonance imaging (MRI) scan of the skull base, demonstrating a Left Glomus Jugulare Paraganglioma. The CT scan on the left shows bone erosion and destruction involving the left jugular foramen. The MRI on the right reveals a brightly enhancing, lobulated mass in the same region, consistent with the diagnosis.
Glomus Jugulare – Radiology Board Review
- Clinical: Middle-aged adults (40-60y), F>M; pulsatile tinnitus, hearing loss, cranial neuropathies (CN IX, X, XI); mass effect at skull base; rare familial syndromes with SDH mutations
- Etiology/Pathophys: Paraganglioma of neuroendocrine origin arising from paraganglia in the jugular foramen region; hypervascular tumor derived from glomus bodies associated with tympanic/auricular branches of CN IX/X
- Radiograph: Permeative, moth-eaten bone destruction of the jugular foramen; irregular bone erosion adjacent to tumor mass
- CT: Lobulated soft tissue mass in left jugular foramen with intense post-contrast enhancement; bone erosion and destruction of adjacent skull base including jugular foramen; no middle ear involvement
- MRI: T1 iso- to hypointense lobulated mass with “salt-and-pepper” appearance due to flow voids and hemorrhage; T2 hyperintense with multiple punctate flow voids; intense homogeneous or heterogeneous enhancement post-gadolinium
- Nuc Med: Increased tracer uptake on somatostatin receptor imaging (e.g., Ga-68 DOTATATE PET/CT); MIBG scan less sensitive for head and neck paragangliomas; useful for detecting multifocal/metastatic disease
- Signs: “Salt-and-pepper” appearance on MRI due to slow flow/high vascularity; jugular foramen erosion on CT as a classic sign of glomus jugulare tumor
- Frameworks: Fisch classification (A-D) based on extent of local invasion and surgical resectability; important for planning treatment and prognosis
- DDx: Petrous bone/cholesteatoma (no intense enhancement, bone remodeling rather than destruction); schwannoma (more homogeneous, less vascular, no flow voids); meningioma (dural tail, less bone destruction)
- Tx: Surgical excision in accessible lesions; preoperative embolization to reduce vascularity; radiotherapy for unresectable or residual tumor; surveillance for multicentric disease in hereditary cases
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