At the Viewbox: Glomus Vagale

Glomus Vagale

A 37-year-old woman presented with a several year history of a painless left neck mass. She became increasingly concerned, since her mother also had a neck mass which had been recently diagnosed as a carotid body paraganglioma. A contrast-enhanced CT shows intense enhancement of a left carotid space mass. Lateral projection from a digital subtraction angiogram obtained with a left common carotid artery injection demonstrates the hypervascular mass displacing the common carotid artery anteriorly. Indium-111 octreotide scan reveals avid uptake by the tumor.

Paragangliomas are highly vascular tumors of the paraganglia. The most common location in the head and neck is at the carotid bifurcation, termed carotid body tumor. Additional locations include the jugular fossa (glomus jugulare), tympanic cavity (glomus tympanicum), and along the course of the vagus nerve (glomus vagale). This neck mass has all the characteristic clinical and radiologic manifestations of a glomus vagale. The lesions typically present as a slow-growing, painless, lateral neck masses, most commonly located behind the angle of the mandible, with anterior displacement of the carotid artery. A familial occurrence is well documented. The hypervascularity of the tumor results in homogeneous, intense enhancement on contrast-enhanced CT and MRI (not shown), as well as catheter angiography. Additional MR findings include a classic “salt and pepper” appearance secondary to regions of calcification and flow voids (pepper) surrounded by hyperintense and hyperenhancing tumor (salt). The tumor also has early, intense octreotide avidity. This patient’s imaging workup revealed no multicentric disease, and the tumor was successfully treated with preoperative embolization followed by surgical excision.

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