Non Functioning Vagal Paraganglioma in the Infrahyoid Neck: A Case Report

Paragangliomas are rare mostly benign, highly vascular tumors that derive from paraganglionic tissue of neural crest origin. Vagal paragangliomas account for only 3% of all head and neck paragangliomas. Most of the paragangliomas are seen in the rostral portion of the vagus nerve in the vicinity of the ganglion nodosum. Patients with vagal paragangliomas typically present with an asymptomatic neck mass and, less frequently, with cranial neuropathies. Most of the head and neck paragngliomas are non secretory as only 1-3% of all head and neck paragangliomas secrete catecholamines. MRI scans are more useful than the CT scan due to better soft tissue contrast delineation. The mainstay treatment is surgical removal. We report a patient with non -functioning vagal paraganglioma located in the infra-hyoid carotid sheath. The findings of diagnostic imaging workup like ultrasonography, computed tomography, and magnetic resonance, were suggestive of paraganglioma. The tumor could not be separated from the vagus nerve and was resected along with the nerve segment. Head and neck surgeons should be aware of the rare presentation of the vagal paraganglioma in the lower neck apart from the usual rostral position.