Presentation
Left sensorineural hearing loss and vertigo.
Patient Data
Occupying lesion in the left jugular foramen with heterogeneous signal and classic salt and pepper appearance in T1 and T2 sequences. The ¨salt¨ represents hemorrhage and the ¨pepper¨ flow voids. In the coronal views, you can appreciate the middle ear involvement.
There´s left atlantooccipital joint effusion as an incidental finding.
An erosive lesion in the left jugular foramen with extension to the middle ear cavity involving the cochlear promontory. The lesion shows avid enhancement.
The ossicles are displaced but not eroded.
Case Discussion
The characteristics of the lesion found on the CT scan (erosive on the jugular foramen) are typical of jugular paraganglioma. In this case, is important to note the cranial extension towards the middle ear cavity, which is the finding that most likely caught the attention of the ENT specialist during otoscopy.
On MRI, the salt and pepper appearance are typical in paragangliomas.
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