MRI brain shows a 23 X 23 mm size mass lesion in the right tympanum extending into the jugular foramen with multiple flow voids within. Mass is iso intense on T1WI and shows intense enhancement on post contrast scan.

Glomus jugulare tumors originate from the chief cells of paraganglia, or glomus bodies, located within the wall (adventitia) of the jugular bulb. These are rare, vascular, slow-growing tumors, and most are benign.

Paragangliomas are often found at other sites, including the middle ear (glomus tympanicum tumor), the carotid body (carotid body tumor), and the vagus nerve in proximity to the inferior (nodosum) vagal ganglion (glomus vagale tumor, glomus intravagale tumor).

Glomus jugulare tumors occur predominantly in women in the fifth and sixth decades of life.

Plain skull radiography may show enlargement of the lateral jugular foramen and fossa.

Permeative destructive bone changes along superolateral margin of JF mark extent if tumor.

1.Jugular spine erosion is common.

2.Vertical segment of petrous ICA posterior wall often dehiscent.

3.Mastoid segment of facial nerve may be engulfed.

4.Homogenous intense enhancement.

Lesions >2cm demonstrate characteristic ‘salt &pepper’ appearance.

1.Salt refers to hyerintense foci within tumor that represents hemorrhage or slow flow.

Hyperintense foci relatively rare MR imaging finding.

2.Pepper refers to numerous hypointense foci within tumor representing high velocity arterial branch flow voids.

Hypointense foci common MR imaging finding.

3.Intense enhancement is rule.

Mixed hyperintense mass with hypointense foci (pepper).

Unless carotid arteriography is necessary for preoperative evaluation and/or embolization, noninvasive techniques are preferred; however, for large tumors involving the internal carotid artery (ICA), preoperative carotid arteriography with cross-compression or trial balloon occlusion is recommended. The venous drainage systems also need to be carefully studied before sinus occlusion is carried out during surgical resection.

For tumors with large intracranial extension, vertebral arteriography is advised to exclude arterial feeders from the posterior circulation.

Surgery is the treatment of choice for glomus jugulare tumors. Surgical approach depends on the localization and extension of the tumor.