題目

glomus jugulare tumour - a paraganglioma of the head and neck，位於 jugular fossa，雖然它一種rare tumour，但它卻是jugular fossa 最常 見的tumor。 Clinical presentation: 臨床症狀取決於 middle ear involvement 的程度，較嚴重時，會出現 pulsatile tinnitus and hearing loss，除此之外，如果jugular foramen 的 nerve 受到侵犯，可能會出現: 1.Vernet syndrome (motor paralysis of cranial nerves IX, X, and XI)像是 Hoarseness，soft palate dropping，deviation of the uvula towards the normal side，dysphagia 2.Collet-Sicard syndrome (Vernet syndrome with additional involvement of cranial nerve XII) 3.Horner syndrome 影像診斷: CT: most useful at assessing the bony margins of the tumour, which are typically irregularly eroded with a moth-eaten pattern. MRI: T1 - low signal T2 - high signal T1 C+ (Gd) - marked intense enhancement 頸靜脈球瘤主要以搏動性耳鳴(pulsatile tinnitis)及聽力減退為主要特徵,也可能因cranial nerve IX,X,XI palsy而而吞吞嚥困難及聲音沙啞的表現。此種頸靜脈球瘤會在注射顯影劑後的 T1加權影像呈現 marked intense enhancement,如圖上箭頭所示, 故選(A)。