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Jugular Bulb Pseudolesion
Karen L. Salzman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Jugular bulb (JB) pseudomass; "leave alone" lesion of jugular foramen (JF)
            • Definitions

              • Asymmetric, large JB flow phenomenon simulates neoplasm or thrombosis on MR sequences

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Totten DJ et al: Persistent conductive hearing loss after tympanostomy tube placement due to high-riding jugular bulb. Laryngoscope. 131(4):E1272-4, 2021
                                        2. Liu GS et al: Systematic review of temporal bone-resurfacing techniques for pulsatile tinnitus associated with vascular wall anomalies. Otolaryngol Head Neck Surg. 160(5):749-61, 2019
                                        3. Sarioglu FC et al: Variations of the vascular canals in the cochlear implant candidates. Int J Pediatr Otorhinolaryngol. 123:123-7, 2019
                                        4. Manjila S et al: Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications. Neurosurg Focus. 45(1):E5, 2018
                                        5. Yeo WX et al: Surgical management of pulsatile tinnitus secondary to jugular bulb or sigmoid sinus diverticulum with review of literature. Am J Otolaryngol. 39(2):247-52, 2018
                                        6. Kizildag B et al: The relationship between tinnitus and vascular anomalies on temporal bone CT scan: a retrospective case control study. Surg Radiol Anat. 38(7):835-41, 2016
                                        7. Mortimer AM et al: Endovascular treatment of jugular bulb diverticula causing debilitating pulsatile tinnitus. J Neurointerv Surg. 8(3):e11, 2016
                                        8. Bae SC et al: Single-center 10-year experience in treating patients with vascular tinnitus: diagnostic approaches and treatment outcomes. Clin Exp Otorhinolaryngol. 8(1):7-12, 2015
                                        9. Mundada P et al: CT arteriography and venography in the evaluation of pulsatile tinnitus with normal otoscopic examination. Laryngoscope. 125(4):979-84, 2015
                                        10. Sakaida H et al: Dehiscent high jugular bulb attached to the tympanic membrane. Ear Nose Throat J. 94(6):210; 212, 2015
                                        11. Atmaca S et al: High and dehiscent jugular bulb: clear and present danger during middle ear surgery. Surg Radiol Anat. 36(4):369-74, 2014
                                        12. Shaikh MF et al: A novel approach for surgical repair of dehiscent high jugular bulb. Laryngoscope. 123(7):1803-5, 2013
                                        13. Shweel M et al: Diagnostic utility of magnetic resonance imaging and magnetic resonance angiography in the radiological evaluation of pulsatile tinnitus. Am J Otolaryngol. 34(6):710-7, 2013
                                        14. El-Begermy MA et al: A novel surgical technique for management of tinnitus due to high dehiscent jugular bulb. Otolaryngol Head Neck Surg. 142(4):576-81, 2010
                                        15. Fayad JN et al: Jugular foramen tumors: clinical characteristics and treatment outcomes. Otol Neurotol. 31(2):299-305, 2010
                                        16. Friedmann DR et al: Clinical spectrum of patients with erosion of the inner ear by jugular bulb abnormalities. Laryngoscope. 120(2):365-72, 2010
                                        17. Vachata P et al: An anatomical and radiological study of the high jugular bulb on high-resolution CT scans and alcohol-fixed skulls of adults. J Clin Neurosci. 17(4):473-8, 2010
                                        18. Meckel S et al: Display of dural sinuses with time-resolved, contrast-enhanced three-dimensional MR venography. Cerebrovasc Dis. 25(3):217-24, 2008
                                        19. Dai PD et al: Morphological and positional relationships between the sigmoid sinus and the jugular bulb. Surg Radiol Anat. 29(8):643-51, 2007
                                        20. Bilgen C et al: Jugular bulb diverticula: clinical and radiologic aspects. Otolaryngol Head Neck Surg. 128(3):382-6, 2003
                                        21. Tsunoda A: Sensorineural hearing loss caused by a high jugular bulb. J Laryngol Otol. 114(11):867-9, 2000
                                        22. Palacios E et al: Jugular bulb appearing as a mass. Ear Nose Throat J. 78(8):536, 1999
                                        23. Caldemeyer KS et al: The jugular foramen: a review of anatomy, masses, and imaging characteristics. Radiographics. 17(5):1123-39, 1997
                                        24. Atilla S et al: Computed tomographic evaluation of surgically significant vascular variations related with the temporal bone. Eur J Radiol. 20(1):52-6, 1995
                                        25. Tomura N et al: Normal variations of the temporal bone on high-resolution CT: their incidence and clinical significance. Clin Radiol. 50(3):144-8, 1995
                                        26. Dietz RR et al: MR imaging and MR angiography in the evaluation of pulsatile tinnitus. AJNR Am J Neuroradiol. 15(5):879-89, 1994
                                        27. Okudera T et al: Development of posterior fossa dural sinuses, emissary veins, and jugular bulb: morphological and radiologic study. AJNR Am J Neuroradiol. 15(10):1871-83, 1994
                                        28. Ongre A: The jugular bulb once more. AJR Am J Roentgenol. 135(5):1117, 1980
                                        29. Stern J et al: Jugular bulb diverticula in medial petrous bone. AJR Am J Roentgenol. 134(5):959-61, 1980
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Jugular bulb (JB) pseudomass; "leave alone" lesion of jugular foramen (JF)
                                                  • Definitions

                                                    • Asymmetric, large JB flow phenomenon simulates neoplasm or thrombosis on MR sequences

                                                  IMAGING

                                                  • General Features

                                                    • CT Findings

                                                      • MR Findings

                                                        • Angiographic Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Totten DJ et al: Persistent conductive hearing loss after tympanostomy tube placement due to high-riding jugular bulb. Laryngoscope. 131(4):E1272-4, 2021
                                                                              2. Liu GS et al: Systematic review of temporal bone-resurfacing techniques for pulsatile tinnitus associated with vascular wall anomalies. Otolaryngol Head Neck Surg. 160(5):749-61, 2019
                                                                              3. Sarioglu FC et al: Variations of the vascular canals in the cochlear implant candidates. Int J Pediatr Otorhinolaryngol. 123:123-7, 2019
                                                                              4. Manjila S et al: Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications. Neurosurg Focus. 45(1):E5, 2018
                                                                              5. Yeo WX et al: Surgical management of pulsatile tinnitus secondary to jugular bulb or sigmoid sinus diverticulum with review of literature. Am J Otolaryngol. 39(2):247-52, 2018
                                                                              6. Kizildag B et al: The relationship between tinnitus and vascular anomalies on temporal bone CT scan: a retrospective case control study. Surg Radiol Anat. 38(7):835-41, 2016
                                                                              7. Mortimer AM et al: Endovascular treatment of jugular bulb diverticula causing debilitating pulsatile tinnitus. J Neurointerv Surg. 8(3):e11, 2016
                                                                              8. Bae SC et al: Single-center 10-year experience in treating patients with vascular tinnitus: diagnostic approaches and treatment outcomes. Clin Exp Otorhinolaryngol. 8(1):7-12, 2015
                                                                              9. Mundada P et al: CT arteriography and venography in the evaluation of pulsatile tinnitus with normal otoscopic examination. Laryngoscope. 125(4):979-84, 2015
                                                                              10. Sakaida H et al: Dehiscent high jugular bulb attached to the tympanic membrane. Ear Nose Throat J. 94(6):210; 212, 2015
                                                                              11. Atmaca S et al: High and dehiscent jugular bulb: clear and present danger during middle ear surgery. Surg Radiol Anat. 36(4):369-74, 2014
                                                                              12. Shaikh MF et al: A novel approach for surgical repair of dehiscent high jugular bulb. Laryngoscope. 123(7):1803-5, 2013
                                                                              13. Shweel M et al: Diagnostic utility of magnetic resonance imaging and magnetic resonance angiography in the radiological evaluation of pulsatile tinnitus. Am J Otolaryngol. 34(6):710-7, 2013
                                                                              14. El-Begermy MA et al: A novel surgical technique for management of tinnitus due to high dehiscent jugular bulb. Otolaryngol Head Neck Surg. 142(4):576-81, 2010
                                                                              15. Fayad JN et al: Jugular foramen tumors: clinical characteristics and treatment outcomes. Otol Neurotol. 31(2):299-305, 2010
                                                                              16. Friedmann DR et al: Clinical spectrum of patients with erosion of the inner ear by jugular bulb abnormalities. Laryngoscope. 120(2):365-72, 2010
                                                                              17. Vachata P et al: An anatomical and radiological study of the high jugular bulb on high-resolution CT scans and alcohol-fixed skulls of adults. J Clin Neurosci. 17(4):473-8, 2010
                                                                              18. Meckel S et al: Display of dural sinuses with time-resolved, contrast-enhanced three-dimensional MR venography. Cerebrovasc Dis. 25(3):217-24, 2008
                                                                              19. Dai PD et al: Morphological and positional relationships between the sigmoid sinus and the jugular bulb. Surg Radiol Anat. 29(8):643-51, 2007
                                                                              20. Bilgen C et al: Jugular bulb diverticula: clinical and radiologic aspects. Otolaryngol Head Neck Surg. 128(3):382-6, 2003
                                                                              21. Tsunoda A: Sensorineural hearing loss caused by a high jugular bulb. J Laryngol Otol. 114(11):867-9, 2000
                                                                              22. Palacios E et al: Jugular bulb appearing as a mass. Ear Nose Throat J. 78(8):536, 1999
                                                                              23. Caldemeyer KS et al: The jugular foramen: a review of anatomy, masses, and imaging characteristics. Radiographics. 17(5):1123-39, 1997
                                                                              24. Atilla S et al: Computed tomographic evaluation of surgically significant vascular variations related with the temporal bone. Eur J Radiol. 20(1):52-6, 1995
                                                                              25. Tomura N et al: Normal variations of the temporal bone on high-resolution CT: their incidence and clinical significance. Clin Radiol. 50(3):144-8, 1995
                                                                              26. Dietz RR et al: MR imaging and MR angiography in the evaluation of pulsatile tinnitus. AJNR Am J Neuroradiol. 15(5):879-89, 1994
                                                                              27. Okudera T et al: Development of posterior fossa dural sinuses, emissary veins, and jugular bulb: morphological and radiologic study. AJNR Am J Neuroradiol. 15(10):1871-83, 1994
                                                                              28. Ongre A: The jugular bulb once more. AJR Am J Roentgenol. 135(5):1117, 1980
                                                                              29. Stern J et al: Jugular bulb diverticula in medial petrous bone. AJR Am J Roentgenol. 134(5):959-61, 1980