Spontaneous superficial arteriovenous malformation causing p
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A 58 year old lady was referred to the Otolaryngology clinic with an 18-month history of pulsatile tinnitus. This was associated with an enlarging swelling posterior to her right ear. There was no history of trauma, surgery, or percutaneous procedures to her neck, and she was otherwise medically well.

On examination, there was a soft, compressible, pulsatile swelling overlying the right mastoid process that pulsated in synchronicity with her heartbeat. On auscultation, a bruit was audible. Contrast CT displayed evidence of congestion of the posterior auricular division of the right external carotid artery with a large abnormal vascular channel communicating with the external jugular vein. The channel measured approximately 20 × 21 × 13 mm and was located directly below the tip of the right mastoid.

The swelling was excised surgically. Intra-operatively a large, thin-walled vein with a small arterial supply was identified deep to the lesion. The lesion was removed in toto. Following surgical excision, the patient's symptoms completely resolved.

Spontaneous AVFs in the head and neck are rare and a significant proportion are associated with genetic or connective tissue diseases. They classically present as a pulsatile neck mass, sometimes accompanied by associated audiovestibular and neurological signs and symptoms. Treatment options include conservative management, endovascular intervention, or surgical excision.

Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.3670?af=R