A 44 y/o woman with Pulsating tinnitus

Doctor's Information

Name : Morteza
Family :Sanei Taheri
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Resident : Morteza Babaii

Patient's Information

Gender : Female
Age : 44

Case Section

Head & Neck Imaging

Clinical Summary

A 44 y/o woman with Pulsating tinnitus,with subsequent conductive hearing loss &progressive sensorineural hearing loss .

Images

Imaging Procedures and Findings

Ct scan reveals Destructive mass in right petrosal apex. MRI shows corresponding lesion with low signal in T1WI and high signal in T2WI , and severe enhancement after Gad . This mass arising near the jugular fossa. Angiography shows hyper vascular mass extending to jugular fossa , with feeding vessels from external carotid artery .

Discussion

Glomus jugulare tumor show bony destructive distortion at the separation of jugular fossa and hypotympanum.The tumors commonly invade the hypotympanum.There may be displacement of the tympanic membrane and the long process of the malleus and erosion of the basal turn of the cochlea.On CT scan,invasion into the infralabyrinthine compartment result in a mottled apprarance.infralabyrinthine involvement may destroy the vertical and horizontal portions of the carotid canal.MR is valuable in defining the full extent of the lesion. CT often demonstrates moth-eaten destruction of the bone surrounding the jugular fossa, with MR revealing the typical heterogeneous salt and pepper signal related to numerous flow voids. Malignant tumors are often indistinguishable from paragangliomas on CT, but most fail to demonstrate flow voids on MR. Other lesions of the jugular fossa include schwannomas (arising from cranial nerves IX to XI) and meningiomas. These lesions cause a smooth expansion of the jugular foramen with marked enhancement. Additionally, schwannomas may demonstrate cystic components.