Pulsatile tinnitus and the vascular tympanic membrane: CT, MR, and angiographic findings

The radiologic studies of 107 patients with pulsatile tinnitus or a vascular retrotympanic mass were retrospectively reviewed. Of the 100 patients with pulsatile tinnitus, 25 had objective tinnitus. A vascular tympanic membrane was present in 37 cases (35%). Normal vascular variants were present in 23 patients (21%). Twenty-seven patients (25%) had acquired vascular lesions. Temporal bone tumors were found in 33 patients (31%). No abnormality was identified in 21 cases (20%). To ensure optimal radiologic examination, it is imperative to know the nature of the tinnitus (objective vs subjective) and the appearance of the tympanic membrane. All patients with subjective pulsatile tinnitus or a vascular retrotympanic mass should undergo high-resolution computed tomography of the temporal bone as the initial imaging study. Angiography is recommended for patients with objective tinnitus and a normal tympanic membrane. The role of MR imaging, even with the addition of gradient-echo techniques, remains limited and secondary.

Popliteal cysts: presentation as thrombophlebitis

Synovial-lined cysts in the popliteal space associated with rheumatoid arthritis or meniscal tears may compress the popliteal vein and produce signs and symptoms suggestive of thrombophlebitis. Because of a presumptive diagnosis of thrombophlebitis, venography may be performed initially and demonstrate compression of the popliteal vein by an extrinsic mass. The correct diagnosis of a popliteal cyst can easily be made with B-mode ultrasonography, and, if desired, confirmed by arthrography. Four cases are presented which emphasize these features.