Glomus jugulotympanicum paraganglioma

Case contributed by Andrew Dixon


Asymptomatic skull base abnormality initially detected on trauma imaging.

Patient Data

Age: 55 years
Gender: Female

Skull base


Mass lesion centered within the left jugular foramen with tympanic extension to the cochlear promontory and which descends into the carotid space just below the skull base. It enhances vividly and demonstrates mixed T2 and T1 signal including many small low signal flow voids creating a salt and pepper appearance. The mass causes complete effacement of the left internal jugular vein and displaces the left internal carotid artery anteriorly. Altered flow signal within the left transverse and sigmoid sinuses on the T1 images is likely due to slow flow, with no thrombosis seen on the post-contrast images.

Bilateral paramedian inferior frontal lobe gliosis (best seen on coronal T2 images) is in keeping with prior traumatic brain injury. Abnormal low T2 signal within the posterior aspect of the right cavernous sinus relates to coils from prior transvenous treatment of carotid-cavernous fistula. 

Skull base


Irregular bone erosion (moth-eaten appearance) is seen at the margins of the left jugular foramen with the soft-tissue mass extending into the middle ear cavity at the cochlear promontory. The bone erosion and growth pattern are typical features of glomus jugulotympanicum paragangliomas and are useful to help distinguish between schwannoma which will cause smooth remodeling of the foramen.  

Annotated image

T2 fat saturated and T1 images demonstrating low signal flow voids within a carotid space mass (red arrows) which descends for the jugular foramen. This is the classic "salt and pepper" appearance of paraganglioma.

Axial bone CT shows irregular erosion of bone at the margin of the jugular foramen (yellow arrows) which is a useful feature to help differentiate paragangliomas from schwannomas which tend to cause smooth remodeling of the foramen.  

Case Discussion

Left glomus jugulotympanicum paraganglioma with typical MRI and CT imaging characteristics.  This was discovered incidentally in the setting of traumatic brain injury. This patient has a past history of previous right caroticocavernous fistula transvenous coil embolization.  

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.