Pulsatile tinnitus and imaging diagnosis. A case report.

Tinnitus is the perception of sound in one or both ears when no external noise exists to cause that perception. It can be otological, neurological, drug-related, traumatic, due to exposure to high decibel levels, or associated with a vascular abnormality-the latter usually causing pulsatile tinnitus. We present the diagnostic image of a patient with pulsatile tinnitus with terminal plate dehiscence of the jugular bulb and review the diagnostic workup. Jugular bulb dehiscence is a venous variant that consists of an upper and lateral extension of the jugular bulb into the middle ear through a dehiscent sigmoid plate. It is the most common vascular anatomical variant of the petrous portion of the temporal bone. Imaging studies are essential for establishing a diagnosis and defining possible anatomical variants.

Anatomical variations of the acromial and coracoid process: clinical relevance.

PURPOSE: The acromial and coracoid process morphology is of clinical relevance due to associations with functional limitations and shoulder pathology. Our objective was to describe the anatomical characteristics of the acromial and coracoid process using computed tomography (CT). METHODS: Descriptive, observational, transversal and retrospective study. A total of 155 CT of patients without shoulder pathology, of both genders, and indistinct age were evaluated and grouped by age: Group 1 < 25 years; group 2 25-40 years; group 3 > 40 years. The following parameters were evaluated: Acromial type (AcT), vertical coracoid distance (VCD), acromial tilt (AT), acromial projection (AP), critical shoulder angle (CSA), type of the subcoracoid outlet (TSO), and the area of the subcoracoid outlet (ASO). RESULTS: Statistically significant differences were found between men and women for VCD (14.44 ± 4.79 vs. 11.76 ± 4.00 mm; p < 0.001) and AP (3.66 ± 4.71 vs. 1.62 ± 4.99 mm; p < 0.05) as well as between age groups 1 and 3 for AT (35.08 ± 11.53 vs. 28.41 ± 6.60; p < 0.05) and ASO (398.99 ± 153.91 vs. 255.56 ± 124.58 mm2; p < 0.001). An unexpected high ASO variation was identified with 11% of S-shaped acromion and 1.3% clock-shaped TSO. CONCLUSION: The age group between 25-40 years had the most uniform distribution of data. There is a high morphological variability present in an asymptomatic population, which should be considered in the clinical assessment such as shoulder impingement syndrome.

The Importance of Esophagography in Patients With Recessive Dystrophic Epidermolysis Bullosa.

OBJECTIVE: The purpose of this study was to assess esophageal damage in patients with recessive dystrophic epidermolysis bullosa (RDEB) with or without dysphagia. SUBJECTS AND METHODS: Fourteen patients with either severe generalized or another generalized form of RDEB recruited through a research and support foundation were evaluated for obstructive esophageal lesions by means of barium esophagography. RESULTS: All patients, even those without dysphagia, had at least one stenosis; five patients had two stenoses. Stenotic lesions occurred most often (74%) in the upper third of the esophagus. CONCLUSION: Esophageal stenosis is a common complication in patients with RDEB, even when they do not have dysphagia. We recommend regular esophagographic examinations of all patients with RDEB.