Glomus vagale masquerading as a carotid body tumor: A diagnostic surprise - A Case Report.

BACKGROUND: Glomus vagale tumors are rare paragangliomas that arise along the vagus nerve, typically within the parapharyngeal space. Their clinical presentation often involves symptoms of vagus nerve dysfunction, such as hoarseness, dysphagia, or parapharyngeal mass. However, they may occasionally mimic other paragangliomas, such as carotid body or jugular tumors, which can make diagnosis challenging.

CASE PRESENTATION: A 65 years old lady, known case of hypertension presented to the vascular surgery clinic with complaint of painless swelling in the left side of the neck for the last 10 months. Pre-operatively there was a 5 x 6 cm firm swelling at the left lateral cervical region with Fontaine sign positive. CT scan neck was done which showed a left carotid body tumor. The patient underwent pre-operative angio-embolization of carotid body tumor followed by surgical resection. However intra-operatively the tumor was encasing the vagus nerve and was extending below from the jugular foramen, a frozen section was sent which reported as paraganglioma. Mass was completely removed along with segments of vagus nerve. Postoperatively, the patient experienced transient hoarseness, which resolved on follow-up, with no evidence of persistent vagus nerve dysfunction.

CLINICAL DISCUSSION: Glomus vagale has overlapping symptoms with carotid body tumors, hence it may be challenging to differentiate both clinically. However, to plan the surgical approach it is utmost important to diagnose it correctly.

CONCLUSION: Glomus vagale tumors may occasionally present as cervical masses. Even on advanced imaging they may masquerade as carotid body tumors. Given their proximity to vital neurovascular structures, a multidisciplinary approach is essential to ensure safe and effective management.