Head and neck #8

Where is the lesion?

Left carotid sheath posterior to the carotid bulb, internal, and external carotid arteries.

How does it look like?

Large oval avidly enhancing lesion displacing the carotid bifurcation anteriorly.

What is the differential diagnosis?

Carotid bulb paraganglioma: avidly enhancing lesion with characteristic splaying of the internal and external carotid arteries (lyre sign).
Glomus vagale: paragangliomas but of the vagus nerve, located posterior to the carotid arteries displacing them anteriorly.
Vagal schwannoma: those that arises within the carotid sheath posteriorly but usually shows moderate enhancement compared with the avid enhancement of the paragangliomas.

What is the most likely diagnosis

Glomus vagale

2 thoughts on “Head and neck #8

  1. Isn’t is so, that Glomus vagale is typically located higher in the neck and a schwannoma may also conrast intensively? Frankly speaking I would suggest the vagal schwannoma as the 1st DD

    1. The glomus vagale tumors can occur along the path of the vagus nerve they do not necessarily locate higher in the neck. This avid, intense type of enhancement is more characteristic of a extra-adrenal neuroendocrine tumour.

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