Diagnosis

Glomus intravagale frequently presents as a neck mass near the origin of the sternocleidomastoid muscle in association with paralysis of the ipsilateral vocal cord (Figure 16-13).48,66 With progressive tumor growth, a Horner's syndrome frequently develops, as do multiple cranial neuropathies and pharyngeal pain secondary to irritation of the pha-ryngeal plexus.66 Radiographic imaging demonstrates the presence of a mass in the posterior portion of the carotid sheath that displaces the carotid artery anteriorly (Figure 16-14). The differential diagnosis for a glomus intravagale includes neural tumors (neurofibromas and schwannomas) that arise from the lower cranial nerves or the cervical sympathetic chain. Unlike the other paragangliomas which manifest very low rates of malignant transformation and distant metastasis, glomus intravagale may

Figure 16-14. Glomus intravagale on angiogram, displacing carotid sheath structures.

Figure 16-13. Glomus intravagale.

Figure 16-14. Glomus intravagale on angiogram, displacing carotid sheath structures.

metastasize in nearly 20 percent of cases with pulmonary metastases occurring most commonly.66

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