Imaging Study in Pulsatile Tinnitus: A Case Report

Introduction: Pulsatile tinnitus is a rare condition and has its origins in arterial and venous structures in the head and neck. Malformations, tumors, and anatomical variations are well known causes of pulsatile tinnitus. However, a radiological investigation is necessary in order to identify the specific etiology.

Objectives: The objective of this study is to present a case of unilateral pulsatile tinnitus, with an otoscopic alteration suggesting vascular etiology, not detected in usual imaging studies.

Resumed Report: A 43-year-old female patient (A. T. S.) presented with a left unilateral hearing loss and pulsatile tinnitus, for 2 years, to the otolaryngology department, without any periods of remission. A physical examination revealed a reddish lesion bulging out of the anterior superior quadrant of the left tympanic membrane, no cranial nerves deficit was detected. Audiometry showed a left conductive hearing loss. As for imaging examinations, it was initially requested a temporal bone computed tomography (CT), showing a complete opacification of the left mastoid cells, and a soft tissue density material in mastoid antrum, "aditus ad antrum," and Prussak space, bulging the tympanic membrane. The remaining structures were preserved. For better detailing, a magnetic resonance angiography (MRA) was performed, both considered normal. Finally, a cerebral arteriography revealed an arterial "blush" flowing from a branch of the petrous segment of the internal carotid artery, overlapping the temporal bone.

Conclusion: Although, CT and MRA are widely used for the investigation of vascular lesions of the temporal bone, sometimes it is necessary to use more invasive tests for a proper diagnosis.

Keywords: Pulsatile tinnitus, vascular abnormalities.