Venous Hum

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Cardiol Young 2001 Nov;11(6):643-6
Can fibrotic bands in the aortic arch cause innocent murmurs in childhood?
Nothroff J, Suemenicht SG, Wessel A.
Department of Paediatric Cardiology, University Children's Hospital Goettingen, Georg-August-University Goettingen, Germany.

Children with innocent murmurs are often referred to a paediatric cardiologist for diagnosis. The most common murmurs of early childhood are the so-called Still's murmurs, followed by ejection murmurs across the pulmonary or aortic vessels, and the venous hum. There also exists a high coincidence of murmurs with the presence of tendinous structures traversing the cavity of the left ventricle. In this report, we describe 6 patients who presented to our outpatient clinic with cardiac murmurs. None of them had abnormalities on the clinical examination, electrocardiographic, or echocardiographic investigation. They presented a similar murmur that was also audible over the back. On closer examination of the aorta with cross-sectional echocardiography, we discovered echogenic, tendinous structures crossing the lumen of the descending aorta or the aortic arch. Whilst we are not yet able to prove that the cords produced the innocent murmurs, the association is highly suggestive.

J Gastroenterol 1996 Aug;31(4):618-22
Cruveilhier-Baumgarten syndrome in which venous hum disappeared following endoscopic variceal sclerotherapy.
Yamakawa O, Ohta H, Watanabe H, Motoo Y, Okai T, Kadoya M, Matsui O, Sawabu N.
Department of Internal Medicine, Kanazawa University, Japan.

We report a case of Cruveilhier-Baumgarten syndrome associated with portal vein thrombosis that developed, slowly during a 2-year period after endoscopic variceal sclerotherapy. The thrombosis led to the disappearance of the venous hum and the dilated abdominal wall veins characteristic of this syndrome. A 73-year-old woman was hospitalized for treatment of esophageal varices in April 1988. Her spleen was markedly enlarged, and the histologic findings of her liver were not consistent with hepatic cirrhosis, but with idiopathic portal hypertension. A venous hum was audible in the upper abdomen. Superior mesenteric angiography revealed a porto-systemic shunt vessel under the abdominal wall, originating from the umbilical vein. She was injected four times with a sclerosant, and this brought about disappearance of the esophageal varices. Two years after the first admission, the venous hum was no longer audible, but there was a recurrence of the esophageal varices. More than 2 years later (4 years after the first admission), ultasonographic study, computed tomography, and angiography showed a large thrombus, which completely obstructed the portal vein at the origin of the umbilical vein, and the development of collateral vessels, seen as a "cavernous transformation."

J Laryngol Otol 1993 Nov;107(11):1037-8
Ligation of the internal jugular vein in venous hum tinnitus.
Nehru VI, al-Khaboori MJ, Kishore K.
Department of Otolaryngology, Al Nahda Hospital, Ruwi, Muscat, Sultanate of Oman.

Vascular anomalies, extracranial and intracranial arteriovenous malformations as well as glomus jugulare tumour are well known causes of pulsatile tinnitus. Of late, benign intracranial hypertension has been stated to be a more common cause. However, tinnitus arising from and within the internal jugular vein has been reported only infrequently. Previously known as cephalic bruit and essential objective tinnitus, the venous hum tinnitus presents as pulse synchronous unilateral objective tinnitus. Ligation of the internal jugular vein appears to be a successful treatment. Two cases are presented.

Kinderarztl Prax 1992 Dec;60(9-10):291-3
Arteriovenous fistula of the blood vessels of the neck--a rare differential diagnosis of venous hum in childhood
Scholbach T.
Kinderklinik des Stadtischen Klinikums "St. Georg" Leipzig.

In a case report it is shown that in rare circumstances there might be an extracardial organic cause for heart murmurs sounding accidentally. In a child with the finding of a venous hum an arterio-venous fistula between the right common carotid artery and the right internal jugular vein could be demonstrated by colour-coded echocardiography. The clinical relevance of this finding is discussed.

J Hepatol 1990 Sep;11(2):279-80
On the rarity of Cruveilhier-Baumgarten's venous hum.
Salmi A, de Cotiis R, Rusconi C.

J Cardiol 1989 Sep;19(3):885-92
Venous hum and innominate vein flow velocity in chronic anemia: a pulsed Doppler echocardiographic study
Shiota T, Sakamoto T, Amano K, Takenaka K, Hasegawa I, Suzuki J, Amano W, Saito Y, Sugimoto T.
Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo.

To assess the hemodynamic correlates of the cervical venous hum in patients with chronic anemia, 14 patients (mean age; 49 years, mean hemoglobin (Hb); 7.3 g/dl) and 14 control subjects (mean age; 50 years, mean Hb; 14 g/dl) without cardiac disease were studied by auscultation, phonocardiography and Doppler echocardiography in two positions (supine and sitting). Venous hum was detected in the sitting position in 11 of the 14 anemic patients whose Hb was less than 9 g/dl, and in six anemic patients in the supine position, while venous hum was absent in the control subjects in both positions. Pulsed Doppler echocardiography with the transducer in the supraclavicular fossa revealed significantly (p less than 0.01) higher peak velocity in the innominate vein in the 11 anemic patients with venous hum (supine; 71 +/- 12, sitting; 111 +/- 24 cm/sec, mean +/- SD) than in the control subjects (supine; 46 +/- 15 sitting; 76 +/- 27 cm/sec) in both positions. Intensity of venous hum increased concomitantly with increased innominate vein flow velocity when the body position was changed from supine to sitting. Peak velocity in the innominate vein correlated significantly with Hb in all study subjects (r = 0.65, p less than 0.01). In conclusion, the cervical venous hum in patients with chronic anemia is related to the hemoglobin concentration and flow velocity in the innominate vein.

Ann Otol Rhinol Laryngol 1985 May-Jun;94(3):267-8
Venous hum as a cause of reversible factitious sensorineural hearing loss.
Rothstein J, Hilger PA, Boies LR Jr.

Self-heard venous hums have been previously documented and recognized as one cause of audible pulsatile tinnitus. A patient presented with a right internal jugular venous hum causing audible tinnitus and a right sensorineural hearing loss, both of which resolved after high ligation of the right internal jugular vein. We speculate that the hearing loss measured initially was factitious and represented a masking effect due to the venous hum.

Nervenarzt 1984 Dec;55(12):651-4
Pseudostenosis sounds and angiographic findings
Betz HS.

The suspicion of a carotid interna stenosis a short distance above the bifurcation because of a clear stenotic bruit on auscultation of the neck area proved to be unjustified in several cases, when angiography control was performed. In most cases, the superior thyroid artery was atypically developed (struma). An arterio-venous fistula of A. occipitalis was also wrongly suspected to be a carotid interna stenosis a short distance above the bifurcation, even when examined by Doppler ultrasonography, because of increased murmur of blood flow. When auscultating carotid bifurcation, proximal murmur from the heart must be excluded as well as venous hum. The later occurs mostly in hemodialysis patients and children. In approximately 10-20% of stenotic bruit cases in the neck area no stenosis could be detected. On the other hand, in more than 70% of all cases of carotid stenosis a short distance above the bifurcation no flow murmur could be detected by auscultation. The statistics show, however, that in every case of stenotic bruit, a generalised atherosclerosis must be suspected. Every such patient should therefore be carefully examined.

Laryngoscope 1983 Jul;93(7):892-5
Diagnosis and cure of venous hum tinnitus.
Chandler JR.

Sounds arising from abnormalities of or abnormal communications between blood vessels in the neck or cranial cavity may result in objective tinnitus. It is audible to patient and examiner alike. Contrary to the usual subjective tinnitus of non-vascular origin, it is low pitched and pulsatile in character. That tinnitus which arises from and within the internal jugular vein is particularly important, as it may be loud enough to interfere with sleep, and result in some loss of hearing. Diagnosis is important as it can be cured by simple ligation of the internal jugular vein. Such a case is reported.

JAMA 1981 Mar 20;245(11):1146-7
Self-heard venous hums.
Hardison JE, Smith RB 3rd, Crawley IS, Battey LL.
We describe two patients with symptomatic, self-heard venous hums. The venous hum was secondary to chronic anemia in one patient and was idiopathic in the other. The idiopathic hum was not heard in the neck but could be heard by auscultating the right auditory canal. Ligation of the right internal jugular vein abolished the idiopathic hum, which had been present for 14 years.

J Thorac Cardiovasc Surg 1981 Jan;81(1):135-6
Surgical treatment of symptomatic cervical venous hum.
Brennan FJ, Salerno TA.

A 28-year-old woman presented with pulsating tinnitus in the right ear and a venous hum heard over the right internal jugular vein. Maneuvers which abolished the hum also eliminated the tinnitus. Permanent symptomatic relief was achieved by ligation of the right internal jugular vein.

Hepatogastroenterology 1980 Jun;27(3):189-94
Cruveilhier-Baumgarten disease in Japan--on the basis of our own case.
Iwamura K, Itakura M.

The article reports on a patient with Cruveilhier-Baumgarten disease. The anamnesis of the 59-year-old housewife revealed previous anemia, splenomegaly and abnormal liver function 21 years ago. Three years ago, esophageal varices were found. A tortuously distended vein was seen in the falciform ligament at the time of laparoscopy, and this finding was confirmed by angiography and ultrasonography. Esophageal varices and hypersplenism were also noted. Despite these findings, liver biopsy specimens of both lobes showed only slight fibrosis with minimal lymphocyte infiltration in some portal areas, and no evidence of cirrhosis. Patency of the umbilical vein and portal hypertension without significant histologic change of the liver, are both in keeping with the features of this disease. Dilatation of the umbilical vein seemed to be congenital and did not contribute to active blood flow of portal hypertension in this patient. In Japan, development of "caput medusae" in portal hypertension is rather rare, whereas esophageal varices and splenomegaly are more frequent. Venous hum is also seldom found. 14 cases of Cruveilhier-Baumgarten disease and 28 cases of Cruveilhier-Baumgarten syndrome have been reported from Japan in the literature since 1911.

Arch Intern Med 1978 May;138(5):826
Venous hum of the Cruveilhier-Baumgarten syndrome.
Ramakrishnan T.

Postgrad Med 1977 Dec;62(6):131-4
Abdominal examination: role of percussion and auscultation.
Castell DO, Frank BB.

Clinicians should not minimize or overlook the importance of percussion of the liver and the spleen and of auscultation over the liver as routine parts of abdominal examination. Splenic percussion can be used to detect splenomegaly even before the spleen becomes palpable. The span of liver dullness on percussion can be compared with established normal standards to detect hepatomegaly or alterations caused by cirrhosis. A systolic bruit, a friction rub, or a venous hum detected by auscultation over the liver is an important sign of liver disease.

Arch Intern Med 1977 Nov;137(11):1623-4
Venous hum of the Cruveilhier-Baumgarten syndrome: response to the Valsalva maneuver.
Hardison JE.

The response of the venous hum of the Cruveilhier-Baumgarten syndrome (CBS) to respiration, the cardiac cycle, and changes in posture is not predictable. The Valsalva maneuver may result in an increase in intensity of the hum rather than a decrease. The Cruveilhier-Baumgarten venous hum (CBH) is virtually diagnostic of portal vein hypertension. It may be mistaken for obscure cardiac murmurs. The Cruveilhier-Baumgarten venous hum, unlike the cervical venous hum (CVH), is never present in normal people.

J Fam Pract 1977 Apr;4(4):637-9
The functional heart murmur: a wastebasket diagnosis.
Napodano RJ.

It is extremely helpful for the examiner to separate murmurs of nonorganic origin into one of two categories. The innocent heart murmur group defines five specific entities: the pulmonary systolic murmur, the vibratory systolic murmur, the supraclavicular systolic murmur, the mammary souffle, and the venous hum. All other nonorganic murmurs are classified as functional, and are produced by clinically recognizable alteration in anatomy and/or physiology affecting the circulatory system. This paper discusses each category and provides information regarding bedside diagnosis of selected murmurs.

Practitioner 1976 Nov;217(1301):783-6
Innocent heart murmurs in children. A survey of 119 patients.
Appleyard WJ, Joseph M.

The clinical findings in 119 children with innocent heart murmurs have been reviewed. The majority were aged between 1 and 5 years, and it was in this age-group also that a maximum incidence of venous hum was recorded. There were no particular ECG or chest X-ray findings.

South Med J 1976 Feb;69(2):242-3
Cruveilhier-Baumgarten disease.
Snyder N, Patterson M, Hughes W.

An unusual case of portal hypertension in an asymptomatic 33-year-old man is presented. The findings of splenomgealy, esophageal and gastric varices, a patent umbilical vein with associated venous hum, and three normal liver biopsies qualify him for the diagnosis of Cruveilhier-Baumgarten disease. Possible etiologic explanations of his portal hypertension are discussed.

N Engl J Med 1975 Aug 14;293(7):360
Letter: Cervical venous hum in hyperthyroidism.
Winternitz WW.

Ann Otol Rhinol Laryngol 1975 Jul-Aug;84(4 Pt 1):473-82
Operative treatment of surgical lesions with objective tinnitus.
Ward PH, Babin R, Calcaterra TC, Konrad HR.

This article discusses the importance of the elevation and diagnosis of objective tinnitus (tinnitus heard by the patient and the physician). Intracranial arteriovenous communications and vascular anomalies are most frequently responsible for the tinnitus and auscultable bruits and are highly amenable to current surgical treatment. While the otolaryngologists may initially see these patients and be responsible for the diagnosis of their problem, the surgical correction of the intracranial lesions is usually the province of the neurosurgeon. Illustrative cases of extracranial causes are presented. Particular emphasis is placed on the diagnosis and treatment of venous hum. Formerly called cephalic bruit and essential objective tinnitus, venous hum is now a recognized nosological entity that is amenable to treatment by ligation of the internal jugular vein.

N Engl J Med 1975 Jun 5;292(23):1239-40
Editorial: The cervical venous hum: a help and a hindrance.
Hardison JE.

Z Kardiol 1975 Jun;64(6):592-4
Venous hum in Paget's disease
Voges K, Holldack K.

J Med Soc N J 1974 Apr;71(4):319
Pseudo venous hum.
Goldfinger P.

Postgrad Med J 1970 Dec;46(542):726-8
Intracranial A-V malformation associated with cranial bruit and cervical venous hum.
Cartlidge NE, Ayyar DR, Lee M.

Am Heart J 1970 Oct;80(4):488-92
The genesis of the cervical venous hum.
Cutforth R, Wiseman J, Sutherland RD.

J Med Assoc Ga 1968 Oct;57(10):479
The cervical venous hum.
Hardison JE.

N Engl J Med 1968 Mar 14;278(11):621-2
The cervical venous hum.

N Engl J Med 1968 Mar 14;278(11):587-90
Cervical venous hum. A clue to the diagnosis of intracranial arteriovenous malformations.
Hardison JE.

Calif Med 1966 Aug;105(2):102-3
The neck venous hum in adults.
Rivin AU.

N Y State J Med 1965 Nov 15;65(22):2797-9
Femoral venous hum.
Tashima CK.

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