 MRI Brain:There is about 13.4mm x 14.1mm x 25mm sized soft tissue mass with high T2/FLAIR signal intensity and flow voids along the distal left cervical ICA to the the level of the left jugular bulb. This is suspicious for a paraganglioma (glomus jugulare). There is minimal scattered periventricular and subcortical T2/FLAIR signal hyperintensity which is nonspecific but likely related to small vessel ischemic disease. There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse volume loss. The ventricles and basal cisterns are otherwise unremarkable. There is no midline shift or herniation. MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA Neck: The left common carotid artery arises from the brachiocephalic trunk which is a normal variant. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion. There is enhancement of the likely left side jugular bulb paraganglioma with suggestion of early venous drainage into the adjacent left internal jugular vein.
1.Large likely left jugular bulb paraganglioma predominately along the petrous portion of the left ICA to the level of the left jugular bulb. No evidence of an acute infarct.2.Questionable partially assessed tongue atrophy which could conceivably be secondary to mass effect on the left hypoglossal nerve by the tumor. Correlate for possible additional CN9-CN11 involvement.3.Prominent left mastoid air cell fluid which is nonspecific but correlate for possible mastoiditis.4.No significant high grade vascular stenosis in the neck or intracranial vasculature.Findings were discussed with the Neurology resident on call, Dr. Santos De Lima (pager 9203) the primary physician taking care of the patient at the time of the finding by Dr. Veronesi, Neuroradiology fellow.