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his teaching case report represents an unusual example of a neck mass in a previously healthy individual. The presence of a new neck mass is a relatively common head and neck problem and requires a full work up including a complete history and physical examination. With respect to our patient, thorough history taking, physical examinations and specific investigations led to the diagnosis of a malignant and functionally active paraganglioma.Vagal paraganglioma themselves are rare tumours and account for only 5-25% of all paragangliomas in the head and neck region. The presence of a malignant, functionally active, catecholamine-secreting paraganglioma is even rarer and accounts for only 1-3% of all reported glomus vagale tumours.This case report illustrates the need to carefully monitor all neck masses for changes in size, for any distortion to surrounding structures, and their given function.