Case 3

I am presented with a CT study of the brain, showing an ill-defined, extra-axial, intracranial soft tissue mass centred around the right jugular bulb, with extension into the posterior fossa. The mass effect is causing effacement of the right cerebello-pontine angle and displacement of the adjacent pons, right middle cerebellar peduncle and cerebellar hemisphere. The caudal aspect of the fourth ventricle is completely effaced, resulting in obstructive hydrocephalus with dilatation of the third and lateral ventricles, as well as generalised cerebral sulcal effacement.  

The mass is causing irregular, permeative bony destruction of the jugular foramen, resulting in expansion of the foramen by the mass. This places the origin of the mass within the jugular foramen.

This mass most likely represents a glomus jugulare tumour. The differential diagnosis includes a nerve sheath tumour or meningioma; however, these would not cause bony destruction.

I would obtain post-contrast CT images in the first instance, where I would expect to see avid post contrast enhancement.

I would also urgently contact the referring physician and inform of the findings. The obstructive hydrocephalus would require urgent decompression.

I would flag this case for discussion at neurosurgical MDT.