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Jugular paraganglioma

Case contributed by Federico Estrada Méndez
Diagnosis almost certain

Presentation

Intermittent chronic dysphagia, vertigo and foreign body sensation in the neck.

Patient Data

Age: 50 years
Gender: Male
ct

 Left oropharyngeal space with the presence of a poorly defined ovoid image with a soft tissue appearance that conditions partial displacement of the vascular space involving the styloid process and partially contacts the base of the skull. It is heterogeneous, predominantly isodense to soft tissues. It has a mean attenuation index of 23 HU in the simple phase and after administration of intravenous contrast medium enhances up to 31 HU, measures 3.3 x 2.0 x 4.0 cm in anteroposterior, transverse and longitudinal diameter, respectively.

mri

Left vascular space with evidence of an oval morphology mass, well-defined edges, located at the level of the left carotid artery in proximity to its bifurcation with an apparent ipsilateral jugular origin, conditioning its medal displacement due to mass effect. Without apparent compromise of its flow. Extension towards the base of the skull is visualized as well as contact with the left cerebellar hemisphere and widening of the jugular foramen, it presents a “Salt and pepper” configuration, with predominantly hypo intense behavior in T1 and T2 sequences, intense and heterogeneous enhancement after the application of paramagnetic contrast IV, measures 34 x 26 x 22 mm in its craniocaudal, anteroposterior and lateral axes. With no evidence of airway or digestive tract involvement or local bone erosion at the time of the study. Normal right vascular space, normal muscle structures, without evidence of adenopathies or ganglion conglomerates.

Artifact is observed at the level of the left maxilla corresponding to a dental piece made of metallic material.

Case Discussion

Jugular paragangliomas arise from the paraganglia cells located in the adventitia wall of the jugular bulb, within the jugular foramen. They have slow growth and are usually benign. However, due to their location, they can cause a mass effect with invasion and erosion of the temporal bone as they increase in size. Only 1% to 5% are malignant.

The estimated annual incidence of jugular paragangliomas has been reported to be about 0.07 per 100,000 per year or 1 case per 1.3 million people.

The median age at diagnosis is 56 years (44 to 69 years). Female presentation is 3 to 6 times more common than men. Among head and neck paragangliomas, 44% to 48% are carotid body tumors, 16% to 24% are jugular paraganglioma, 20% are tympanic paraganglioma, and 8% are vagal paraganglioma.

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