MRI - Skull base
Axial T1
Axial T2 fat sat
Coronal T1
Coronal T2
Axial DWI
Axial ADC
Coronal T1 C+ fat sat
Axial T1 C+ fat sat
Axial T1 C+
Mass lesion centred 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.