A vagal paraganglioma (VP) may present with a number of clinical findings.
Patient selection: vagal paraganglioma
Location of tumor: between the jugular vein and internal carotid artery, from the base of the skull to the lower neck. Most tumors arise from the inferior vagal ganglion (glomus nodosum).
The most common finding is a painless mass:
(1) behind the angle of the mandible
(2) in the lateral neck
(3) in the pharyngeal wall with medial displacement of the tonsil
The patient may have pulsatile tinnitus (ringing in the ear with each heartbeat). Sometimes bruit can be heard by placing the stethoscope over the ear.
Some patients may have cranial nerve deficits:
(1) hoarseness
(2) dysphagia
(3) shoulder drop
(4) hemiatrophy of the tongue
(5) aspiration
If catecholamines are secreted (uncommon), then the patient may have tachycardia, hypertension and diaphoresis.
Tumors may show:
(1) intracranial extension through the jugular foramen with headache
(2) extension into the mastoid tip