Glomus vagale tumour, can it be diagnosed only on sonography?

Abstract

Vagal paragangliomas are rare benign tumors accounting for only 3% of head and neck paragangliomas and arise from vagal ganglions, predominately the nodose ganglion in the carotid sheath. Imaging plays an important role in their diagnosis, differentiation from more common lesions presenting in the carotid space, and management. MRI is the method of choice for investigation when paragangliomas are clinically suspected. The typical salt-and-pepper appearance in T1-weighted images is well known but not specific to paragangliomas. Demonstration of the continuity of the lesion with the vagus nerve on magnetic resonance imaging (MRI) further asserts the diagnosis of glomus vagale. Although this tumor can be diagnosed on a contrast-enhanced computed tomography (CECT) examination, it is limited by the non-demonstration of its neural origin. Sonography is considered only a preliminary investigation in patients, and a CECT and/or MRI study of the neck is conducted before treatment planning. This case is unique as a confident diagnosis of glomus vagale was made on high-resolution sonography of the neck. A middle-aged male patient presenting with a neck swelling was diagnosed with a glomus vagale tumor on USG by the direct demonstration of its continuity with the vagus nerve, and Doppler examination confirmed its vascularity. The diagnosis was confirmed on histopathology after surgical excision. The sonographic appearance, Doppler characteristics, and imaging differential diagnosis of glomus vagale are discussed in detail.

Ultrasound appearance of peripheral nerves in the neck: vagus, hypoglossal and greater auricular

“…Well-defined reference values are essential requirements for high-resolution ultrasound. Although many articles describe the US appearance of nerves in various neuropathies (postoperative nerve injuries or tumors) [6][7][8], information is less abundant when it comes to normal values of peripheral nerves. Moreover, cranial nerves received less attention compared to peripheral nerves [9].…”

Vagal paraganglioma extending to the brain: a case report with literature review

“…CT and magnetic resonance imaging are the required imaging modalities for the diagnosis of VPs and to determine their relationship to the carotid vessels [16] . Magnetic resonance imaging of the mass shows a typical salt-and-pepper appearance [13] . A CT scan for tumors extending to the skull base to better define the details of bone erosion and the extent of involvement is recommended [2] .…”

“…VP presents as a mass in the cervical region and is in close relationship with the internal jugular vein and the carotid vessels. Hence, differentiation from other neck masses in the same anatomic site, such as nerve sheath tumor, carotid aneurysm, or carotid body tumor [13] . Head and neck paragangliomas are commonly considered non-secretory tumors, with few cases secreting catecholamines.…”

“…The role of sonography is limited in the diagnosis and only considered a preliminary investigation [13] . CT and magnetic resonance imaging are the required imaging modalities for the diagnosis of VPs and to determine their relationship to the carotid vessels [16] .…”

A glomus vagale tumorok kivizsgálása és ellátása

“…Kemoreceptív tulajdonságukból adódóan válaszolnak a vér O 2 -, CO 2 -, illetve pH-szintjének változására, így chemodectomáknak is nevezzük őket. Fontos megemlíteni, hogy a legnagyobb malignitási állandóval a glomus vagale rendelkezik, így a diagnózis felállításában a fizikai vizsgálat mellett nagy jelentősége van az UH-nak és az MR-nek, melyek kimutatják az idegi eredetiséget, a végleges diagnózis felállításához azonban nélkülözhetetlen a szövettani eredmény [8,9].…”