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Cardiology
Published in Fazal-I-Akbar Danish, Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Venous hum (continuous murmur-like sound audible in the neck when the patient is standing, sitting or reclining against pillow; disappears when patient assumes a horizontal or head-down position):1 Kinking of large neck veins (common in children).
Accident and Emergency
Published in Nagi Giumma Barakat, Get Through, 2006
These often occur with systole - except for a venous hum, which is a continuous murmur. They are often localized, usually along the left sternal border. They are usually of grade 3, not more, and are not associated with a thrill. The intensity of the murmur changes with position, except in the case of a venous hum. Cyanosis never occurs with an innocent murmur. Still’s murmur is most commonly heard in patients aged 2-7 years. It is usually a grade 3, musical, buzzing systolic ejection murmur. It is maximally heard in the third intercostal space and is louder in supine position than when sitting. It is louder with exercise, excitement and fever. Answer: D
Head and neck
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Monitoring of the (buried) flap can be a problem and options include Anterior neck window to expose the serosa of the underlying flap, which is tacked to the skin, possibly covered with a thin SSG (Bafitis H, Plast Reconstr Surg, 1989) or closed after the third day.Daily endoscopic inspection (beginning on the fifth day).Sentinel loop – exteriorising a minor segment of the flap (~2 cm) to observe colour, secretion and peristalsis (Katsaros J, Br J Plast Surg, 1985). This segment is excised ~5 days under LA.A similar method can be used for tubed fasciocutaneous flaps, e.g. ALT with multiple perforators.Alternative methods include Handheld Doppler – mark position of the anastomosis on skin at the end of surgery; the pedicle always runs in an ‘unnatural’ course and usually more superficial. Venous hum is said to be a more specific feature.Colour duplex Doppler.Implantable Doppler probe – a standard of sorts but still not wholly reliable as it may detect other vessels.Christian Doppler (1803–1853) was an Austrian physicist.Angiography.
Radiologic features of vascular pulsatile tinnitus – suggestion of optimal diagnostic image workup modalities
Published in Acta Oto-Laryngologica, 2018
Ah-Ra Lyu, Sung Jae Park, Dami Kim, Ho Yun Lee, Yong-Ho Park
There were several studies demonstrating the causes of pulsatile tinnitus. Waldvogel et al. [10] postulated that the most common lesion was a dural arteriovenous fistula or a carotid-cavernous sinus fistula among the 36 patients with vascular pulsatile tinnitus. On the contrary, Sonmez et al. [11] demonstrated that the most common cause was high jugular bulbs, followed by atherosclerosis, jugular bulb dehiscence, aneurysm of internal carotid artery, dural arteriovenous fistula, aberrant internal carotid artery, jugular diverticulum and glomus tumor. More recently, Bae et al. [2] showed that a high jugular bulb was the most common cause, followed by venous hum from various venous lesions in 65% (37/57) of patients. In our series, we classified the origin of the lesions as venous, arterial or intermediate. Among the 49 patients with vascular pulsatile tinnitus, a venous origin was seen in about 84% (41/49). The most common venous cause were jugular bulb variants (80% in venous lesion, 67% in all lesion) such as high riding jugular bulb, dehiscence and diverticulum, followed by sigmoid sinus variants such as diverticulum and dehiscence. The reason for a slightly higher incidence of venous lesions in our series compared to others may be due to the exclusion of several cases of tumorous condition such as glomus tympanicum and glomus tumor of the jugular bulb. Interestingly, 88% (36/41) of venous lesions were on the right. Although there were few reports about laterality in this condition, there was a report showing that asymmetry of the internal jugular vein (IJV) was noted in 62.5% and the dominant vein was the right in 68% of patients [13]. More recently, another report using ultrasound examination showed that the right IJV was dominant over the left IJV in 72% of patients [14]. This tendency of a right-sided dominant IJV may be one of the reasons why there are more pulsatile tinnitus of venous origin affecting the right side.