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Patients who have glomus jugulare tumors often

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present with tinnitus because of the

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hypervascular nature of the lesion and its close

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proximity to the temporal bone and

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the internal auditory canal.

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They hear that whooshing sound of the

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hypervascular flow within the tumor.

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They may also present with cranial neuropathies,

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because these tumors grow into the jugular

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foramen where obviously we have

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nine to eleven cranial nerves.

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So let's look at this patient who

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had left-sided tinnitus.

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We're looking at the FLAIR scan on the left

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side. And as we come down to the skull base,

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we see that there is a mass which is growing in

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the jugular foramen. It has posterior

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extension into the sigmoid sinus.

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And it also shows multiple black foci

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identifying it as a hypervascular mass.

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This is sometimes called the salt and

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pepper appearance of a glomus tumor,

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where you have both the tissue which is somewhat

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bright in signal intensity representing the

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salt and the blood vessels which represent

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the foci representing the pepper.

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And as you can see,

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this lesion is growing into the jugular vein.

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Here is the internal carotid artery,

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here's the internal carotid artery on the right

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side. Here's the jugular vein on the right side.

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Here's the jugular vein with the tumor

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with the flow voids within it,

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the hypervascular tumor in the jugular vein.

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And here we can see internal carotid

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artery and jugular vein.

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Let me just point this out with the magic pen.

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We're calling this ICA,

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we're calling this IJV internal jugular vein.

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We're calling this tumor growing

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into the jugular vein,

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as was described in the Johns

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Hopkins Fellows article,

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published and first authored

2:00

by Emmanuel Oru from Italy.

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What's nice is looking at these

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cases on the Sagittal scan.

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The reason why the Sagittal scan is so good is

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because it shows the origin of the jugular

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vein coming through the skull base.

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So as we look at this right side,

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we see the jugular vein coming

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up to the skull base,

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and we see the transverse sinus, sigmoid sinus,

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jugular vein junction.

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Let's look on the involved side.

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This is the left side.

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Here we have the transverse sinus

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coming into this soft tissue,

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which is within the sigmoid sinus and

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then growing into the jugular vein.

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This is the wall of the jugular vein.

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Here you can see,

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I'm not sure whether this is carotid

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artery or distal jugular vein,

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but of quite often the jugular vein,

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this is probably the jugular vein here will

2:58

reconstitute from its brain. Inches in the neck.

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But this is about as beautiful as you're going

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to see the tumor going from the sigmoid science

3:06

through the jugular framen and growing

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into the jugular vein.

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This is highly suspicious for a paraganglioma,

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for a glomistry guillari tumor, rather than,

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for example, a meningioma or a schwanoma.

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Now, one thing to make Gilder Lily here,

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and that is if you're able to determine whether

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or not there is soft tissue up at the level of

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the inner ear structures within the middle ear.

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Because if you see tissue that is

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enhancing in the middle ear,

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we're going to shift from calling this a glomus

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jugulari to a glomus jugulo tympanicum,

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identifying that there is tissue both in the

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tympanic cavity as well as in the jugular,

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foramen this is best identified

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on a post contrast scan.