Jugular Bulb Diverticulum

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RSNA Case Collection


Jugular Bulb Diverticulum :
A jugular bulb diverticulum is a focal projection most usually extending superiorly from the jugular bulb into the deep temporal bone, but may project in any direction. JBD are characterized by continuity with jugular bulb, sharp edges, and lack of aggressive bone destruction, all of which are present in this case. Lateral extension through the sigmoid plate results in a concurrent dehiscent jugular bulb.

Differential diagnoses:Aberrant right internal carotid artery :
An aberrant internal carotid artery is a collateral pathway through the middle ear that passes lateral to the cochlear promontory. It may present with pulsatile tinnitus and as a reddish retrotympanic vascular mass on otoscopic examination (compared to bluish hue for JBD). On CT, there would be an enlarged tympanic canaliculus, soft tissue in the middle ear, and an absent carotid plate, which are not seen in this case.Glomus Jugulare Paraganglioma :
Paragangliomas, the most common jugular fossa tumor, arise in the jugular fossa originating from neural crest derivatives. As opposed to this patient case, CT would show irregular permeative and destructive borders. Angiography would show an intense tumor blush on arterial phase corresponding to the feeding vessel, in keeping with the hypervascular nature of this tumor. On MRI, they would have a salt and pepper appearance due to blood products and flow voids.Sigmoid Sinus Diverticulum :
Sigmoid sinus diverticula are outpouchings from the sigmoid sinus that impinge on the mastoid bone. Remodeling or erosion of the sigmoid plate may be seen on CT. They may be asymptomatic, or present with pulsatile tinnitus. Compared to this patient, the lesion would be more lateral and would abut the mastoid bone.