Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2021; 9(27): 8097-8103
Published online Sep 26, 2021. doi: 10.12998/wjcc.v9.i27.8097
Diploic vein as a newly treatable cause of pulsatile tinnitus: A case report
Peng-Fei Zhao, Rong Zeng, Xiao-Yu Qiu, He-Yu Ding, Han Lv, Xiao-Shuai Li, Guo-Peng Wang, Dong Li, Shu-Sheng Gong, Zhen-Chang Wang
Peng-Fei Zhao, Xiao-Yu Qiu, He-Yu Ding, Han Lv, Xiao-Shuai Li, Zhen-Chang Wang, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Rong Zeng, Guo-Peng Wang, Shu-Sheng Gong, Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Dong Li, Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Hebei North University, Langfang 076350, Hebei Province, China
Author contributions: Zhao PF and Zeng R contributed equally to this work and should be considered co-first authors; Zhao PF and Zeng R conceived of and directed the project; Lv H and Ding HY analyzed and interpreted the imaging findings; Qiu XY and Li XS provided the images; Gong SS, Zeng R, Wang GP and Li D gathered detailed clinical information; Zhao PF reviewed the literature and contributed to drafting the manuscript; Zhao PF and Zeng R revised the manuscript; Wang ZC and Gong SS ensured the integrity of the study; all authors issued final approval for the version to be submitted.
Supported by National Natural Science Foundation of China, No. 61931013 and No. 61801311.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Zhen-Chang Wang, MD, PhD, Chief Doctor, Professor, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, Beijing 100050, China.
Received: April 12, 2021
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.

Keywords: Pulsatile tinnitus, Diploic vein, Imaging, Ligation, Hemodynamics, Case report

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.