Case 197: Malignant Paraganglioma Manifesting with Calvarial Metastases

History A 32-year-old man presented to the emergency department with a slowly worsening headache and right scalp swelling in the past few weeks. The patient's medical history included recently diagnosed Graves disease, which was controlled with medication, and human immunodeficiency virus infection with a CD4 cell count greater than 500 cells per micro-liter and an undetectable viral load. Otherwise, the patient recently had been in good health. A basic serum chemistry test and complete blood count revealed no abnormalities. The emergency department physicians decided to proceed with contrast material-enhanced computed tomography (CT) of the head to evaluate the palpable right scalp soft-tissue swelling. After the CT results were reviewed, magnetic resonance (MR) imaging of the brain and CT of the chest, abdomen, and pelvis were performed.