Bilateral vagal paragangliomas
A 45-year-old man presented with a 1-year history of right neck swelling. He reported increasing episodes of flushing, dizziness, migraine-type headaches, voice changes, and pain, which interrupted her daily activities. On examination, he was normotensive and had a right neck mass at level II; the superior border extended deep to the mandible. Complete head and neck examination, including flexible laryngoscopy and cranial nerve examination, was unremarkable.
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A 3-Tesla MRI scan showed two symmetrical masses, both in right and left carotid spaces with following features:
- T1: hypo-intesity of masses on basal scan.
- T1+C: a rapid wash-in and wash-out (as opposed to the more slow and steady enhancement of a schwannoma).
- T2: bilateral masses with high signal with multiple flow voids, which may give a salt and pepper appearance; salt being blood products from haemorrhage (uncommon) and pepper being flow voids due to high vascularity (common).
Right vocal cord paralysis was also reported.
Vagal paragangliomas are uncommon tumours of the parapharyngeal space that present with distinct clinical and pathological characteristics that differentiate them from similar head and neck tumours. Epidemiology, tumour biology and radiologic appearances are well known but some controversies exist in diagnosis and treatment modalities. Pre-operative diagnosis of the tumour and prevention of postoperative neurological deficits are issues that are still unresolved. Adjunctive procedures to facilitate the rehabilitation of the patients do not seem to reduce post-operative neurological troubles and are not a standardized cure.
- 1. Netterville JL, Jackson CG, Miller FR, Wanamaker JR, Glasscock ME. Vagal paraganglioma: a review of 46 patients treated during a 20-year period. Arch Otolaryngol Head Neck Surg 1998;124:1133-40. [PubMed]
- 2. Groblewski JC, Thekdi A, Carrau RL. Secreting vagal paraganglioma. Am J Otolaryngol 2004;25:295-300. [PubMed]
- 3. Urquhart AC, Johnson JT, Myers EN, Schecther GL. Glomus vagale: paraganglioma of the vagus nerve. Laryngoscope 1994;104:440-5. [PubMed]
- 4. Myers EN, Johnson JT, Curtin HD. Tumours of the parapharyngeal space. In: Myers EN, Suen JY, editors. Cancer of the head and neck. 3rd edn. Philadelphia, PA: Saunders; 1966. p. 562-85.
- 5. Endicott JN, Maniglia AJ. Glomus vagale. Laryngoscope 1980;90:1604-11. [PubMed]
- 6. Moore G, Yarington CT Jr, Mangham CA Jr. Vagal body tumours: diagnosis and treatment. Laryngoscope 1986;96:5323-36. [PubMed]