On contrast-enhanced MRI of the neck, a 50-year-old man with left-sided conductive hearing loss shows an intensely enhancing mass arising from the left jugular foramen, expanding the foramen, with a 'salt-and-pepper' pattern on T2-weighted images. What is the most likely diagnosis?

• A Jugular paraganglioma (glomus jugulare) ✓
• B Acoustic neuroma (vestibular schwannoma)
• C Chordoma
• D Nasopharyngeal carcinoma

Explanation

A jugular paraganglioma (glomus jugulare tumor) arises from paraganglionic tissue at the jugular bulb and is characteristically centered on the jugular foramen, causing its bony expansion. The 'salt-and-pepper' appearance on T2-weighted MRI represents multiple intratumoral flow voids (pepper) interspersed with hyperintense stroma (salt), reflecting the highly vascular nature of paragangliomas. Intense, homogeneous enhancement on post-contrast sequences is typical. Acoustic neuromas are centered on the internal auditory canal and cerebellopontine angle. Chordoma arises from the midline clivus.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.