Presentation
Incidental finding during imaging workup for TIA. Pulsatile tinnitus and hearing loss on follow up assessment.
Patient Data
Typical features of a left-sided jugular paraganglioma with a mixed T1 and T2 signal accounting for the salt and pepper appearance. The lesion is centered within the left jugular fossa. There is an inferior extension within the carotid space. There is a left mastoid effusion. A jugulotympanic paraganglioma is suspected and cannot be excluded. There is no venous sinus thrombosis.
There is an incidental left parietal calcific granuloma.
The CT venogram (with modified windows) confirm irregular erosion (moth-eaten) of the left jugular fossa, with a minimally heterogeneous enhancing mass that extends into the middle ear cavity at the cochlear promontory confirming a combined jugulotympanic paraganglioma. There is a left mastoid tip effusion. There is no venous sinus or jugular venous thrombosis.
There is a solitary punctate calcified granuloma within the left parietal lobe. There is incidental bi-maxillary antral mucosal thickening.
Key images demonstrating findings (see below images).
Case Discussion
Paragangliomas are often an incidental finding during imaging for unrelated purposes and diagnosis. In this instance, the patient presented with a TIA and right hemiparesis which resolved spontaneously and without any further treatment.
The MRI and CT features are typical for a left-sided jugulotympanic paraganglioma with a salt and pepper appearance.
Salt- due to slow flow or hemorrhage and blood products, and in this instance very minimal.
Pepper- due to high vascularity and consequent flow voids.
The irregular, aggressive bone erosion (moth-eaten) is typical for paragangliomas.
Schwannomas cause smooth bone expansion while meningiomas often have hyperostosis.
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