The Valsalva manoeuvre is the forced expiration of air against a closed airway, resulting in increased intra-abdominal, intrathoracic and pharyngeal pressure. It can be performed against a closed glottis or by one closing the mouth and pinching the nose while forcibly exhaling.
It is commonly used to equalise the pressure in the middle ears (when changing altitude or diving under water) and sinuses (if obstructed). It is used in clinical medicine to accentuate certain cardiac sounds and signs due to its effect on venous return.
It is incorporated in medical imaging for dynamic assessment of various diseases such as:
- abdominal hernias
- orbital venous varix
- head and neck venous malformations
- oesophageal reflux and hiatus hernias
- leg deep venous thrombosis
- pelvic congestion syndrome: varicocele of the ovarian veins
The manoeuvre is employed in CT and MRI scanning of the neck to distend the pharynx for mucosal assessment. It is also a known cause of poor vascular contrast opacification causing transient contrast bolus interruption (termed transient interruption of contrast) 3, particularly in CTPA to investigate PE.
The manoeuvre is also a known cause of pneumomediastinum.
History and etymology
Antonio Maria Valsalva (1666-1723) was an Italian anatomist 1 who studied the anatomy of the ear and described the manoeuvre as a method of testing the patency of the Eustachian tube, and also expelling pus from the middle ear.
- 1. Porth CJ, Bamrah VS, Tristani FE et-al. The Valsalva maneuver: mechanisms and clinical implications. Heart Lung. 1984;13 (5): 507-18. Pubmed citation
- 2. Turner AF, Jacobson G. The Valsalva maneuver in the diagnosis of left ventricular aneurysm. Radiology. 1969;93 (1): 9-12. doi:10.1148/23.1.9 - Pubmed citation
- 3. Martin L. Gunn. Pearls and Pitfalls in Emergency Radiology. ISBN: 9781139619899