0:01

This was an individual who was detected for

0:04

a right parapharyngeal space mass that

0:08

was encroaching on the pharynx.

0:10

And this was identified by the ENT surgeon

0:15

who had done the endoscopy.

0:17

Let's look at that parapharyngeal space mass.

0:19

So if we go high up here to

0:21

the parapharyngeal space,

0:22

you can see the deviation of the palatine tonsil

0:28

on the right side by this mass

0:31

on the postgad fatsat scan.

0:33

So this is a postgad fatsat vibe scan with

0:38

thin section imaging showing this mass.

0:41

So let's try to characterize what this mass is.

0:45

As I come from above,

0:47

I note that the Sigmoid sinus and jugular vein

0:51

on the right side appear to be separate from

0:55

this mass here, the jugular vein.

0:57

It's not growing into the jugular vein,

0:59

and it's not in the jugular foramen.

1:02

So that virtually eliminates a glomus jugulari

1:05

tumor. It is, however, within the carotid space.

1:10

And we can see that by the internal carotid

1:13

artery here being displaced anteriorly

1:16

by the mass. Here's our normal internal carotid artery

1:20

and our normal jugular vein.

1:23

So, anterior displacement of the internal

1:26

carotid artery. Well, by virtue of the anterior displacement

1:30

of the internal carotid artery,

1:31

I could say that it is highly unlikely that this

1:34

represents a carotid body tumor since that would

1:37

spray the internal carotid artery posteriorly.

1:41

That said, it's more likely to represent a glomus

1:45

vagale tumor. It is hypervascular.

1:49

You see the flow voids within it.

1:51

This is the T2 CISS image reconstructed

1:55

in coronal fashion.

1:56

And here you can see these dark blood vessels

2:00

within the mass identifying it as a

2:03

hypervascular mass and therefore unlikely

2:06

to represent a schwannoma or a lymph

2:08

node metastasis or something else.

2:11

So this is undoubtedly a glomus vagale tumor.

2:16

For those of you who have keen eyesight,

2:18

you may have noticed that there was a second mass.

2:21

As we come down below,

2:23

we see the glomus vagale tumor,

2:27

and then we come into a second mass

2:31

seen here on the right side.

2:33

This second mass is identifiable just

2:38

above the carotid bifurcation.

2:40

So here's our common carotid artery.

2:42

And if we scroll,

2:44

we see that the right internal carotid artery

2:47

is being displaced posteriorly by the mass.

2:50

The external carotid artery is being displaced

2:54

anteriorly by the mass.

2:56

The mass has flow voids within it,

2:59

seen laterally as well as centrally

3:02

within the mass. And therefore,

3:04

this fulfills the criteria that we would

3:07

expect for a carotid body tumor.

3:11

So multiple paragangliomas on the same side.

3:15

One a carotid body tumor,

3:17

the other glomus vagale.

3:20

We better look at the contralateral side to make

3:23

sure that there is not an additional lesion.

3:26

So here's our carotid bifurcation.

3:28

We look in there now.

3:29

Nothing there.

3:30

A little bit of a lymph node coming up here.

3:34

Nothing else in the carotid,

3:36

chief and at the jugular foramen normal

3:41

sigmoid-sized jugular vein.

3:43

Nothing growing into the jugular vein.

3:45

And hence, it is a unilateral process

3:49

with two paragangliomas,

3:51

a carotid body tumor and a glomus vagale tumor.