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High riding jugular bulb

A high riding jugular bulb is distinguished from an asymmetrically large jugular bulb by its dome (roof) reaching above the internal acoustic meatus (IAM). It need not be larger than the contralateral bulb, but usually is.

A run of the mill high riding jugular bulb has an intact sigmoid plate - a thin plate of bone separating the jugular bulb from the middle ear cavity. This can only be appreciated on thin slice bone algorithm CT, and is too thin to appreciate on MRI.

If the sigmoid plate is deficient, the the bulb is free to protrude into the middle ear cavity, and is then known as a dehiscent jugular bulb and is a common cause of a retrotympanic vascular mass.

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