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nature of glomus tumours accounts for the classic
‘‘salt and pepper’’ appearance on T2 and con-
trast-enhanced T1-weighted MRI resulting from
multiple flow voids against a T2 hyperintense or
enhancing stroma. Hypervascularity is demon-
strated at angiography (
Fig. 4
).
Arterial tinnitus
Arteriopathy
Atherosclerosis is one of the more common causes
of PT, accounting for 8
e
20% of cases (
Table 1
). In
a study of 100 consecutive patients with cerebro-
vascular disease, 29% suffered from PT.
13
Those
with PT were more likely to have severe (greater
than 70%) stenosis, complete occlusion, or ICA dis-
ease (
Fig. 5
).
13
Daneshi et al.
14
investigated
Table 2
Causes of pulsatile tinnitus
Arterial
Arterial anomalies
Aberrant internal
carotid artery
a
Persistent stapedial artery
Neurovascular contact
Arteriopathy
Atherosclerosis
Fibromuscular dysplasia
Internal carotid
artery dissection
Aneurysms
Vascular tumours
Paraganglioma
a
Endolymphatic sac tumour
Meningioma
Haemangipericytoma
Vascular metastases
Haemangioma
Bone dyplasias
Otospongiosis
Paget’s disease
Intrameatal vascular loops
Vascular malformations
and fistulae
Venous
Venous anomalies
High-riding or dehiscent
jugular bulb
a
Aberrant sigmoid sinus
Venous sinus thrombosis
Abnormal emissary vains
Benign intracranial hypertension
Non-vascular
Myoclonus
(palatal, tensor tympani, stapedius)
Chronic middle-ear disease
Dehiscent semicircular canal
a
Evident at otoscopy as retro/intratympanic mass.
Figure 2
Transverse CT image demonstrates an aber-
rant left ICA. The focal projection laterally (arrowhead)
corresponds to a pseudoaneurysm at the site of previous
middle ear exploration.
Figure 3
Transverse CTA/V image demonstrating
a large glomus jugulotympanicum in a patient who pre-
sented with PT (who had previously undergone resection
of a large glomus vagale tumour). There is erosion of the
left jugular fossa up to the horizontal portion of the ca-
rotid canal and of the cochlear promontory. Enhancing
tissue fills the jugular foramen extending to the petrous
apex (black arrow) and middle ear (white arrow).
G. Madani, S.E.J. Connor
72