Glomus Vagale

Glomus vagale, also known as glomus intravagale and vagal paraganglioma, is a tumor that arises from paraganglia in and around the vagus nerve and has a tendency to affect women in the fifth and sixth decades of life. Unlike paragangliomas elsewhere in the body that secrete epinephrine and norepinephrine, most head and neck paragangliomas are hormonally inactive, earning them the moniker "nonchromaffin paragangliomas."

Glomus vagale tumors are the third most frequent head and neck paragangliomas, after glomus jugulare and carotid body tumors (most frequent). Glomus vagale tumors can arise anywhere along the vagus nerve, but the majority arise along the inferiormost ganglion, the ganglion nodosum, located just below the skull base. The tumors are centered in the parapharyngeal space and may extend superiorly through the jugular foramen into the posterior fossa or inferiorly to the carotid bifurcation. Unlike the carotid body tumors, which splay the internal and external carotid arteries, vagal paragangliomas tend to displace both the external carotid artery and internal carotid artery anteromedially.

CT and MRI reveal a well-defined ovoid parapharyngeal mass with intense contrast enhancement. T1-weighted images may a salt and pepper appearance, with high-signal foci ("salt") within the tumor parenchyma corresponding to subacute hemorrhage and low-signal serpentine or punctate foci ("pepper") corresponding to flow voids.

References

• Lee KY, Oh YW, Noh HJ, Lee YJ, Yong HS, Kang EY, Kim KA, Lee NJ. Extraadrenal paragangliomas of the body: imaging features. AJR Am J Roentgenol. 2006 Aug;187(2):492-504.
• Weissman JL. Case 21: glomus vagale tumor. Radiology. 2000 Apr;215(1):237-42.