High Jugular Bulb with Abnormal Intracranial Venous Circulation

Abstract

We treated a 54-year-old female with a high right jugular bulb combined with contralateral abnormal Intracranial venous circulation and discuss the pathogenesis of high jugular bulb. This patient had an episode of right myringoplasty in 1987, and in the course of that surgery, no abnormal mass was found in the middle ear cavity. Six years after surgery, a pulsating blue mass protruding from the hypotympanum was found by an otologist, and she was referred to our clinic with suspected glomus tumor. CT scan showed a mass protruding from the right jugular fossa. Internal carotid artery angiography on both sides revealed expansion and dilation of the right jugular bulb in the venous phase without any abnormality of the arterial system. In the venous phase of left internal carotid artery angiography, an obstruction of the ipsilateral intracranial venous system was observed from the bifurcation of the transverse sinus to the jugular vein. These findings suggest that the abnormality of intracranial venous circulation may result in the development of the high jugular bulb. Intracranial venous obstruction may cause an increase of the contralateral venous blood flow, and this increase of blood flow may result in expansion and protrusion of the jugular bulb into the hypotympanum.