Published online Sep 26, 2021. doi: 10.12998/wjcc.v9.i27.8097
Peer-review started: April 12, 2021
First decision: June 23, 2021
Revised: July 2, 2021
Accepted: August 9, 2021
Article in press: August 9, 2021
Published online: September 26, 2021
Pulsatile tinnitus (PT) is an annoying sound that can be eliminated with targeted treatment of the cause. However, the causes of PT have not been fully elucidated.
A 38-year-old woman with right-sided objective PT underwent preoperative computed tomography arteriography and venography (CTA/V). A 3.8 mm vine diploic vein (DV), which passed through the mastoid air cells posteriorly in a dehiscent canal and was continuous with the transverse-sigmoid sinus, was thought to be the causative finding. Four-dimensional flow magnetic resonance (4D flow MR) imaging showed that the blood in the DV flowed toward the transverse-sigmoid sinus. The closer the blood was to the transverse-sigmoid sinus, the higher the velocity. No vortex or turbulence was found in the DV or adjacent transverse sinus. The sound was eliminated immediately after ligation of the DV with no recurrence during a three-month follow-up. No flow signal of the DV was noted on postoperative 4D flow MR.
A DV may be a treatable cause of PT. CTA/V and 4D flow MR could be utilized to determine the morphological and hemodynamic characteristics of the DV.
Core Tip: This case reports a diploic vein (DV) as a treatable cause of pulsatile tinnitus (PT), which was confirmed by ligation. Thorough examinations, such as computed tomography angiography, magnetic resonance (MR) including four-dimensional flow and digital subtraction angiography, were performed preoperatively to assess the possible venous, arterial and neoplastic causes of the PT; and four-dimensional flow MR was re-examined to show the hemodynamic changes two weeks after ligation. We analyzed the manifestations of the DV, discussed the common features of venous PT in combination with our previous work and the literature, and proposed a potentially efficient diagnosis and treatment strategy for venous PT.