A Case of Pulsatile Tinnitus Associated with Internal Jugular Vein Stenosis Diagnosed by Multidetector-computerized Tomography Angiography

Tinnitus is a discomforting condition associated with a sound in one or both ears that occurs without an external stimulus and can be either pulsatile or continuous. Vascular and non-vascular factors are involved in the aetiology of pulsatile tinnitus (PT), requiring a careful physical examination and evaluation with proper and sophisticated imaging techniques to identify the cause(s). It is known that turning the neck towards the affected ear decreases PT, whereas turning the neck towards unaffected side increases PT from venous hum, due to bending of the internal jugular vein over the transverse process of the atlas leading to increased blood flow. In this report, we sent a rare PT case caused directly by jugular vein stenosis, in which clinical characteristics were in disagreement with the literature. In our case, PT markedly decreased, instead of being aggravated, when turning the neck to the unaffected side in a 35-year-old woman. There was axial maximal intensity above the left jugular bulb and about 85% stenosis in 3-D volume rendering images. We discuss the differential diagnosis by multi-detector-computed tomography angiography with respect to its advantages over other imaging techniques such as CT, MR, MR angiography and conventional angiography.