Imaging Findings Related to the Valsalva Maneuver in Head and Neck Radiology

Jugular phlebectasia. A 72-year-old woman with headaches had a neck CTA performed to evaluate vascular disease. Axial (A) and coronal (B) CTA images show a large right jugular venous aneurysm (arrows). This was deemed to be benign without need for treatment.

Inducible jugular phlebectasia. A 3-year-old boy presented with intermittent right-neck swelling. Sonographic images of the right neck with (A) and without (B) the use of the Valsalva maneuver show significant enlargement of the right internal jugular vein with Valsalva. After additional work-up to exclude any associated cardiovascular or genetic abnormality, the family was reassured that this was consistent with benign jugular phlebectasia.

Laryngocele. A 54-year-old with recent viral upper respiratory infection underwent a contrast-enhanced neck CT. Axial contrast images from this patient show mixed internal and external laryngoceles (A, solid and dashed arrows, respectively). Axial contrast-enhanced CT in an asymptomatic 69-year-old (B) shows a fluid-filled internal laryngocele (arrowhead), which was subsequently resected to confirm the diagnosis.

Spontaneous orbital floor fracture. A 58-year-old woman with chronic sinusitis who presented with sudden left periorbital swelling that started after forcefully blowing her nose. Coronal noncontrast CT images with bone (A and B) and soft-tissue (C) windows demonstrate an open-door-type left orbital floor fracture and orbital/periorbital emphysema. After ophthalmology consultation, which excluded any evidence of orbital muscle entrapment or compartment syndrome, she was discharged with a short course of antibiotics without incident.

Pneumoparotid. A 57-year-old man was referred to the Ear, Nose and Throat department for chronic bilateral parotid swelling and pain, having been previously treated with antibiotics for parotitis with no symptom improvement. The patient reported periodically massaging his parotid glands, which expressed bubbly saliva into his mouth and temporarily alleviated his symptoms. Axial T1-weighted noncontrast axial (A) and coronal (B) MR images demonstrate marked dilation of the parotid ducts bilaterally (arrows). On further questioning, the patient recalled that he had been chronically pursing his lips and putting pressure inside his mouth. He was advised to avoid this in the future and to return should his symptoms worsen.

Hyperpneumatization of the skull base. A 47-year-old woman was referred to the Ear, Nose and Throat department for chronic allergies that caused her to habitually clear her throat. Coronal noncontrast CT of the skull base shows hyperpneumatization of the temporal bones, C1 ring, and dens, which are secondarily opacified (arrows).

Orbital varix. A 70-year-old woman who presented due to an orbital mass incidentally discovered on an outside brain MR imaging. Axial (A and C) and coronal (B and D) CT images of the orbits without (A and B) and with (C and D) a Valsalva maneuver demonstrate inducible enlargement of a lobular structure in the right orbit (arrows), consistent with a varix. The patient subsequently reported right-eye fullness when bending over. No additional treatment was pursued.

Transient global amnesia. A 58-year-old man who presented with retrograde amnesia. He had gone to the gym and completed his usual workout routine including bench-pressing earlier that day. When he returned home, he had no memory of being at the gym despite having recorded his exercises in his daily workout log. An axial diffusion-weighted MR image (A) and a corresponding ADC map (B) show a focus of diffusion restriction in the left hippocampus (arrows). The same findings (arrows) are demonstrated on axial diffusion-weighted (C) and ADC (D) images from a 57-year-old man with mixed retrograde/anterograde amnesia following sexual intercourse.