Roentgen and Clinical Diagnosis of Glomus Jugulare Tumors

Glomus jugulare tumors are rare. Few references to their occurrence are found in the American literature, greater attention having been paid to them in European countries. During the past few years we have encountered 4 cases of glomus jugulare tumor at the Ohio State University Health Center. These cases will be reported here, with special reference to the roentgenologic, angiographic, and clinical features. A special view designed by the author for facilitating their visualization will be described. Anatomy and Pathological Findings The term glomus has been applied to small and sometimes minute neuromyo-vascular aggregations in the form of histologically recognizable bodies. These bodies are composed primarily of fine arterioles connecting directly with veins and rich in nerve supply. They are widely distributed throughout the body and are classified into two main groups. The first or central group includes the carotid, jugular, aortic, and coccygeal bodies. A glomus is also found in the ganglion nodosum of the vagus nerve. In the second or peripheral group are the small bodies in the skin, especially at the ends of the extremities, mainly in the fingers. The function of these bodies is still not completely understood, but they are generally regarded as chemoreceptor organs. The stimuli affecting the peripheral glomera are temperature, touch, and pressure. The stimuli which affect the central group, especially those located in the vessels, are increase in CO2, diminution in oxygen tension, and alteration of pH in the blood. These two groups differ functionally from each other. Stimulation of the peripheral glomera causes only local effects, whereas stimulation of those near the vessels produces systemic results. Glomus tumors (glomangioma, nonchromaffin paraganglioma) represent hyperplasia of all the neuromyo-arterial elements of the normal glomus. They are found in many parts of the body, especially in the tips of the extremities, most commonly in the subungual region of the fingers. They also occur on the flexor surface of the arm, in the region of the knee, in the bones, and in the stomach. The central glomus tumors more frequently arise from the carotid and jugular bodies. Pain is the main symptom of the skin lesions, which are therefore known as painful subcutaneous tumors. In glomus tumors of the central group pain is not an outstanding clinical feature. Glomus jugulare tumors arise from cell masses of exactly the same structure as the glomus caroticum. Such cell masses are partially located in the adventitia of the bulb of the jugular vein, near the tympanic branch (nerve of Jacobson) of the glossopharyngeal nerve, near the auricular branch (nerve of Arnold) of the vagus, and immediately below the bony floor of the middle ear. The tumors may arise from the bulb of the jugular vein and may grow into the middle ear and from there into the external auditory meatus.