Background This study investigates a rare cause of pulsatile tinnitus related to a dehiscent duplication of the jugular bulb associated with a non-stenotic dominant oblique occipital sinus. We report a series of treated patients and describe a novel radiological feature—the ‘playing card heart sign’. Methods In this retrospective single-center study, four patients presenting with venous pulsatile tinnitus due to five dehiscent jugular bulb duplications associated with a non-stenotic dominant oblique occipital sinus were included between January 2023 and September 2024. Clinical assessment included symptom onset, body mass index, and Tinnitus Handicap Inventory score. High-resolution temporal bone CT scans and cerebral venous imaging were used to identify anatomical anomalies. Patients with a significant clinical impact underwent endovascular stenting. Outcomes were assessed at follow-up. Results The mean patient age was 41.9 years, with a median body mass index of 27.4 kg/m². Tinnitus was unilateral in three patients and alternating in one. Imaging revealed a bony dehiscence overlying a duplicated jugular bulb, ipsilateral to a non-stenotic dominant oblique occipital sinus, with no venous pressure gradient. Stenting (n=5) led to complete resolution of tinnitus in all patients, with a median follow-up of 15 months and no reported complications. Conclusions Jugular bulb duplication with dehiscence, associated with a non-stenotic dominant oblique occipital sinus, represents an under-recognized cause of pulsatile tinnitus. This condition can be effectively treated with stenting. Identification of the ‘playing card heart sign’ on imaging is key for accurate diagnosis and management.
Guédon et al. (Wed,) studied this question.