case_images: PMC11152541_01
case_images: (a) Axial contrast-enhanced computed tomography (CT) image through the posterior skull base demonstrating an enhancing lesion centered along the right jugular fossa with associated bony destructive changes of the inferior petrous temporal bone and jugular spine. This lesion is contiguous to the jugular bulb (blue arrow) and abuts the posterior aspect of the distal cervical internal carotid artery (red arrow). (b) Coronal CT image in bone windows demonstrating destruction of the inferior petrous temporal bone (blue arrow), with erosion through the floor of the tympanic cavity, abutting the cochlear promontory (red arrow).
case_images: JCIS-14-14-g001.jpg
case_images: PMC11152541_01_JCIS-14-14-g001.jpg
case_images: F1
case_images: In December 2022, computed tomography (CT) imaging of the neck showed an ill-defined enhancing lesion of the right jugular fossa with associated bony erosive changes of the inferior petrous temporal bone and jugular spine [Figure 1].
case_images: (a) Axial T1-weighted image through the posterior skull base demonstrating a heterogeneous mass lesion with "salt and pepper" signal intensity (blue arrow) and prominent flow voids (red arrow). (b) Axial fat-saturated T2-weighted image through the posterior skull base demonstrating loss of the expected flow void in the right sigmoid sinus (blue arrow), corresponding to aberrant flow dynamics versus occlusion related to the tumor in the jugular fossa. The contralateral flow void (red arrow) is shown for comparison. (c) Coronal T2-weighted image through skull base at the level of the cochlea demonstrating tumoral extension into the middle ear cavity along the cochlear promontory (blue arrow).
case_images: JCIS-14-14-g002.jpg
case_images: PMC11152541_01_JCIS-14-14-g002.jpg
case_images: F2
case_images: Further, evaluation with magnetic resonance imaging showed a lobulated T2 iso to mildly hyperintense mass lesion with intralesional flow voids centered in the right jugular foramen with herniated and erosive changes of the surrounding bone and occlusion of the right jugular bulb, consistent with a paraganglioma [Figure 2].
case_images: (a) Pre-treatment and (b) post-treatment imaging of the lesion, both on axial fat-saturated T2-weighted magnetic resonance imaging. The post-treatment study was performed shortly after completion of radiation therapy and demonstrates cessation of growth, with stable to minimally decreased size of tumor in maximal transaxial dimension (yellow lines).
case_images: JCIS-14-14-g003.jpg
case_images: PMC11152541_01_JCIS-14-14-g003.jpg
case_images: F3
case_images: Follow-up imaging showed T2 isointense to mildly hyperintense mass lesion with intralesional flow voids centered in the right jugular foramen with permeative and erosive changes of the surrounding bone and occlusion of the right jugular bulb, with overall size slightly decreased [Figure 3].