Answer:
Left Jugular Schwannoma
Findings-:
There is a dumb bell shaped mass extending from the left jugular foramen to nasopharyngeal carotid space inferiorly. The lesion has its waist in the jugular foramen and shows homogenous enhancement on contrast study. There is encroachment of left hypoglossal canal . There is also fatty muscle atrophy of the tongue on left side due to possible extrinsic compression of hypoglossal nerve.
Discussion:
Although the fatty tongue atrophy in a patient should arouse the suspicion of hypoglossal schwannoma, schwannomas of the jugular foramen can encroach the hypoglossal canal and can cause secondary compression of the nerve. In these cases, careful evaluation of hypoglossal canal and jugular foramen with 3 D CISS sequences helps in delineating the epicenter of the lesion.
Note: Hypoglossal Schwannoma is also accepted as a right answer, since the CISS sequence was not provided.
Contributed By: Dr. Arun Chelladurai MD, Dr. Karunakaran M. Kalathi MD
Consultant Radiologists, Aarthi Scans, Thirunelveli, Tamilnadu, India
Left Jugular Schwannoma
Findings-:
There is a dumb bell shaped mass extending from the left jugular foramen to nasopharyngeal carotid space inferiorly. The lesion has its waist in the jugular foramen and shows homogenous enhancement on contrast study. There is encroachment of left hypoglossal canal . There is also fatty muscle atrophy of the tongue on left side due to possible extrinsic compression of hypoglossal nerve.
Discussion:
Although the fatty tongue atrophy in a patient should arouse the suspicion of hypoglossal schwannoma, schwannomas of the jugular foramen can encroach the hypoglossal canal and can cause secondary compression of the nerve. In these cases, careful evaluation of hypoglossal canal and jugular foramen with 3 D CISS sequences helps in delineating the epicenter of the lesion.
Note: Hypoglossal Schwannoma is also accepted as a right answer, since the CISS sequence was not provided.
Contributed By: Dr. Arun Chelladurai MD, Dr. Karunakaran M. Kalathi MD
Consultant Radiologists, Aarthi Scans, Thirunelveli, Tamilnadu, India