© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:139-140 • 0278-4297
A Convenient Sonographic Technique for Diagnosis of Pulsatile Tinnitus Induced by a High Jugular Bulb
Minoru Nakagawa, MD,
Norimitsu Miyachi, MLT and
Kenjiro Fujiwara, MD
Department of Neurosurgery (M.N., K.F.) and Clinical Laboratory (N.M.), Kosei General Hospital, Hiroshima, Japan.
Address correspondence to Minoru Nakagawa, MD, Department of Neurosurgery, Kosei General Hospital, 3-3-28 Minami, Mihara, Hiroshima 723-8686, Japan. E-mail: ydhm18357{at}yahoo.co.jp
 |
Abstract
|
|---|
Objective. The purpose of this report is to describe our experience with sonography in a case of pulsatile tinnitus (PT) due to a high jugular bulb (HJB). Methods. A 71-year-old woman came to our hospital with a 1-year history of right PT. A right HJB was shown on cerebral angiography, and enlargement of the right jugular blub compared with the left side was found. First, the ultrasound probe was placed on the anterior right upper neck at the anterior edge of the sternocleidomastoid muscle to identify the ipsilateral internal jugular vein (IJV) and measure the flow velocity. After the measurement, the ultrasound probe gradually compressed the skin until the flow in the IJV decreased. Results. The patient reported that her PT decreased after the flow in the IJV decreased. We decided that the PT in this case was induced by the HJB. Conclusions. This technique is less invasive and convenient for the diagnosis of PT caused by an HJB.
Key Words: brain • high jugular bulb • pulsatile • sonography • tinnitus Abbreviations: HJB, high jugular bulb • IJV, internal jugular vein • PT, pulsatile tinnitus
|
Introduction
|
|---|
A high jugular bulb (HJB) is one of the causes of pulsatile tinnitus (PT). Radiographically, the most common cause of PT has been an HJB, and it has been found in 21% of all cases of PT.1 However, without a sonographic examination, it is difficult to confirm that an HJB actually causes PT. In this report, we describe a sonographic technique for determining whether an HJB induces PT. We report the use of this technique in a patient with PT due to an HJB initially found by digital subtraction angiography. The diagnosis of PT due to venous flow was made during insonation of the ipsilateral internal jugular vein (IJV) by compression of the neck to decrease the flow velocity in the IJV. This technique is noninvasive and confirmatory for the diagnosis and cause of PT.
|
Materials and Methods
|
|---|
A 71-year-old woman came to our hospital with a 1-year history of right PT. No abnormal findings appeared on plain computed tomography or magnetic resonance imaging. Because a dural arteriovenous fistula was suspected, cerebral angiography was performed sequentially (Figure 1 ). A right HJB was shown on the angiogram, and enlargement of the right jugular blub compared with the left side was found. Sonography was performed with an SSD-5000 system (Aloka Co, Ltd, Tokyo, Japan) and a 4- to 10-MHz linear probe to determine whether the HJB induced the PT. First, the ultrasound probe was put on the right anterior neck to examine the ipsilateral internal carotid artery by B-mode sonography. Excessive compression to the neck was avoided. Then the probe was placed on the anterior right upper neck at the anterior edge of the sternocleidomastoid muscle to identify the ipsilateral IJV and measure the flow velocity. After the measurement, the ultrasound probe gradually compressed the skin until the flow in the IJV decreased (Figure 2).
View larger version (210K):
[in this window]
[in a new window]
|
Figure 1. A right HJB (arrow) and enlargement of the right jugular bulb compared with the left side are shown on angiography.
|
|
View larger version (107K):
[in this window]
[in a new window]
|
Figure 2. The right IJV is interrogated with B-mode sonography (arrow). The flow curve of the right IJV is taken by spectral Doppler sonography (arrowhead). The decrease in the flow in the IJV obtained by compression of the IJV is shown on spectral Doppler sonography (asterisk).
|
|
|
Results
|
|---|
The patient reported that her PT decreased after the flow in the IJV decreased. We decided that the PT in this case was induced by the HJV.
|
Discussion
|
|---|
There are numerous causes of PT, such as the presence of an HJB, atherosclerosis, a dehiscent jugular bulb, an aneurysm of the internal carotid artery, a dural arteriovenous fistula, an aberrant internal carotid artery, a jugular diverticulum, and a glomus tumor.1 However, it is difficult to confirm that these entities actually cause PT. Usually, the cause of PT is determined on the basis of the patient’s symptoms and the radiographic findings. In patients with PT, our sonographic technique can determine whether the decrease in the flow in the IJV improves the symptoms. In patients with cervical internal carotid artery stenosis, compression of the neck by the ultrasound probe should be done with caution to avoid producing a cerebral embolism from the cervical internal carotid artery stenosis or confusing the diagnosis because compression of the ipsilateral internal carotid artery would likely decrease the PT symptoms. The compression technique we report may be a reasonable first approach to diagnosing the cause of PT, or it may be used to narrow the differential diagnosis in patients who have already undergone cerebral angiography.
|
Footnotes
|
|---|
Received July 30, 2007, from the Department of Neurosurgery (M.N., K.F.) and Clinical Laboratory (N.M.), Kosei General Hospital, Hiroshima, Japan. Revision requested August 13, 2007. Revised manuscript accepted for publication August 29, 2007.
|
References
|
|---|
- Sonmez G, Basekim CC, Ozturk E, Gungor A, Kizilkaya E. Imaging of pulsatile tinnitus: a review of 74 patients. Clin Imaging 2007; 31:102–108.[Medline]
|
|
Top
Abstract
Introduction