Wk 3, Case 5 - Review

Patient History
Right pulsatile tinnitus.

Findings
Brain: Sagittal T1-weighted images demonstrate corpus callosum to be intact. No evidence of Chiari malformation. No abnormal pineal region masses. Pituitary gland is not enlarged. Diffusion imaging demonstrates no evidence of recent infarct. Axial FLAIR and T2 weighted images show the ventricular size, shape and configuration to be within normal limits. No evidence of vasogenic edema or mass effect. Scattered polypoid mucosal thickening involving multiple paranasal sinuses with mucosal thickening involving the alveolar recess of the right maxillary sinus.

Skull Base: There is an avidly enhancing mass involving the right skull base that is centered in the right jugular foramen that is displacing the carotid artery anteriorly. The mass measures approximately 2.6 cm x 2 cm (axial plane) x 1.9 cm (CC). The mass contains multiple areas of low attenuation that could be characterized as a "salt and pepper" appearance. The mass has heterogeneous T2 signal. The mass anteriorly displaces the carotid artery. The inferior aspect of the mass extends below the skull base and is in close proximity to the right stylomastoid foramen and appears to involve the expected location of the facial nerve as it exits the stylomastoid foramen.

There is asymmetric enhancement of the tympanic and descending portion of the right facial nerve which could be associated with irritation of the facial nerve due to possible involvement by the mass. The superior aspect of the mass extends anterosuperiorly into the right petroclival fissure and is posterior to the petrous portion of the right carotid artery.

Conclusions
1. Avidly enhancing mass involving the right jugular foramen containing multiple flow voids is most consistent with a glomus jugulare tumor.
2. The location of the glomus jugulare is in close proximity to the descending portion of the right facial nerve as it exits the stylomastoid foramen. This is associated with asymmetric enhancement of the tympanic and descending portion of the right facial nerve.
3. Scattered polypoid mucosal thickening as described above.
4. No evidence of vasogenic edema or mass effect.
5. No abnormal intra-axial enhancing masses.