Pulsatile tinnitus: Audiologic and MR imaging diagnostic lssues

Pulsatile tinnitus often presents a diagnostic and management dilemma to the neurologist. Correct diagnosis is imperative because in the majority of cases, there is a treatable underlying etiology. In addition, failure to make proper diagnosis may be disastrous because in some patients, a life-threatening intracranial disease may be present. This study was carried out aiming to investigating the feasibility of differentiating the possible causes of pulsatile tinnitus, particularly in patients with normal otoscopy, using clinical, audiological and radiological, tools. 29 patients complaining of pulsatile tinnitus were evaluated by history taking, clinical examination, laboratory investigations, otoscopy, basic audiological evaluation, MRI for petrous bone and brain and MRA. Glomus jugulare tumor was diagnosed in 3 patients. Benign intracranial hypertension [BIH] was diagnosed in 4 patients. Intraventricular neoplasm in 2 patients. Internal carotid artery stenosis in one patient. Post-traumatic pseudoaneurysm in one patient. Scalp AVM in one patient. Temporal bone metastasis in one patient. Severe anemia in one patient and no identifiable cause [idiopathic] in 15 patients. A unilateral mild low frequency pseudosensorineural hearing loss was identified in 10 patients with normal otoscopy. Hearing loss was normalized after elimination of tinnitus by applying a light digital pressure over the ipsilateral internal jugular vein

jugular foramen: a review of old and new imaging techniques and diagnoses

The imaging anatomy of the jugular foramen [JF] has been described. This is followed by an account of the various historical techniques used for diagnostic visualization. It is obvious that imaging interest has swung almost entirely to newer modalities as a result of dissatisfaction with plain films and conventional tomograms. In many parts of the world, places where no imaging facilities are available, a base view 50-70 degrees short of full extension, and a lateral oblique view are still of value in diagnosing a large foramen or fossa. Demonstration of the exact anatomic details of the bone is not possible without high resolution computed tomography [HRCT]. Conventional pleuridirectional tomography has retreated but remained complementary to computed tomography and a valuable tool in its absence. Computed tomography [CT] and magnetic resonance [MR] provide more information on intracranial or extracranial extensions of tumours as well as on the involvement of adjacent soft tissues. Four-vessel arteriography and jugular venography add important diagnostic characterization. The diagnostic criteria for each of the pathological conditions and the size of the lesion has been described with the justification for the use of a particular techniques. In nontumoral conditions, CT demonstrates smooth intact margin of the JF, except in cerebral venous thrombosis where phase contrast MR venography is the imaging modality of choice. In most tumoral lesions CT shows areas of infiltrative bone involvement, most schwannomas and meningiomas cause smooth enlargement rather than erosion. The multiplanner nature of MR imaging gives better definition and extent of soft tissues lesions, as well as more specific diagnostic criteria. Most of the tumors show low to intermediate signal intensity on T1- weighted images, and intermediate to high intensity on T2-weighted images, and enhance strongly. Each lesion requires a combination of available modalities to reach the specific diagnosis, sometimes the use of three dimentional CT is indicated, particularly in pre- and postsurgical intervention

Tumor metastático no glomus jugular / Metastatic tumors in glomus jugular

Os autores descrevem um caso incomum de metástase de adenocarcinoma renal, localizado na regiäo petrosa e occiptal da base do crânio, onde o diagnóstico diferencial com tumor do glomus da jugular só foi posível após estudo histológico. Tumores metastáticos chegam comumente ao osso temporal por via hematogênica. Salientam também a dificuldade do diagnóstico pré-operatório. Em geral, o diagnóstico da metástase do osso temporal é baseado na suspeita clínica, confirmada pelos exames por imagem.

Cholesterol granuloma coincidence with a large and high jugular bulb: report of a case.

We present a case of right middle ear mass who had an abnormal large jugular foramen, high jugular bulb and large jugular vein on the same side. CT scan could not exclude a glomus tumor. Theoretically, retrograde jugular venography and carotid angiography will give the most useful information. However, in this case we tried to use the MRI scan instead. It showed high signal in T1W, T2W, GRT2W which correlated with blood pigments of methemoglobin in middle ear and mastoid. The low signal in MRI scan T1W, T2W clearly showed enlarged jugular vein, high jugular bulb with diverticulum which helped to excluding a glomus tumor. This finally turned out to be a cholesterol granuloma coincidence with abnormal enlarged jugular foramen and jugular vein. We suggest the MRI scan is very helpful and much safer for patients compared to angiography.

Glomus timpânico: relato de um caso / Glomus tympanic: report of a case

Os tumores glômicos säo abordados em seus aspectos histológico e clínico, de exames complementares ao diagnóstico e quanto ao tratamento. A seguir os autores ilustram estes comentários com um caso de glomus timpânico operado no serviço de otorrinolaringologia do Hospital Universitário Clementino Fraga Filho (HUCFF) - Universidade Federal do Rio de Janeiro (UFRJ)

Glomus jugular: descriçäo de um caso clínico / Glomus jugulare: report of a clinical case

Descreve-se um caso de Glomus Jugularis, diagnosticado no Serviço de Otorrinolaringologia da Santa Casa da Misericórdia de Mirassol, sendo que para este intento foi realizado um minucioso exame clínico, teste audiológico, radiografias contrastadas e de todos os achados clínicos e terapêuticos do caso com a bibliografia consultada, buscando dar maiores subsídios ao conhecimento deste tipo de patologia tumoral