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cta Otorrinolaringol Esp. 2012;63(4):324

www.elsevier.es/otorrino

MAGES IN OTORHINOLARYNGOLOGY

ulsatile Tinnitus From Bovine Aortic Arch Variant�

cúfeno pulsátil por arco aórtico bovino

aría José Lesmas Navarro,∗ Carlos De Paula Vernetta, Verónica Rodríguez Rivera

ervicio de Otorrinolaringología, Hospital Universitario La Fe, Valencia, Spain

hen synchronous with arterial pulse, pulsatile tinnitusften has a vascular origin. It may be due to different causes,ncluding vascular malformations, venous angiomas, vascu-ar tumours (glomus), increased intracranial pressure andlood flow alterations, among others. Magnetic resonancengiography is the test of choice for the diagnosis of mostrterial alterations.

We report the case of a 50-year-old woman who pre-ented pulsatile, chronic tinnitus in the right ear with over5 years evolution, which increased with physical activitynd decreased with cervical compression at the level of thearotid region. She did not suffer hearing loss, vestibularr neurological symptoms. Physical examination was unre-arkable, with audiometry revealing a normal otoscopy andilateral normoacusis.

Magnetic resonance angiography (Fig. 1) showed a bovineortic arch variant of the left common carotid whichtemmed from a right arterial trunk and elongation of theasilar artery.

The normal anatomical configuration of the aortic archonsists of 3 major vessels originating from this arch: innom-nate artery (brachiocephalic trunk), left common carotidrtery and left subclavian artery.

The so-called bovine aortic arch variant is a congenitalnomaly of the aortic arch, whereby the brachiocephalicrunk and left common carotid artery arise from a com-on trunk which stems from the aortic arch. It is the most

� Please cite this article as: Lesmas Navarro MJ, et al. Acúfeno pulsáti∗ Corresponding author.

E-mail address: mariahoo@hotmail.com (M.J. Lesmas Navarro).

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173-5735/$ – see front matter © 2010 Elsevier España, S.L. All rights re

Figure 1

l por arco aórtico bovino. Acta Otorrinolaringol Esp. 2012;63:324.

ommon congenital anomaly of the aortic arch (10%). Thisascular malformation may be a rare cause of pulsatile tin-itus. Its pathophysiological mechanism is possibly relatedo turbulences in arterial blood flow.

served.