What is the diagnosis for a patient presenting with intermittent, non-painful pulsating sensations behind the ear, forearm, and left thigh?

From the Guidelines

For a patient presenting with pulsating, throbbing sensations behind the ear, forearm, and left thigh that are intermittent and non-painful, I recommend a comprehensive workup focusing on vascular and neurological causes, as suggested by the most recent guidelines from the American College of Radiology Appropriateness Criteria 1. The initial evaluation should include:

• Vital signs with blood pressure measurements in both arms
• Complete blood count
• Comprehensive metabolic panel
• ESR/CRP to assess for inflammatory conditions A thorough cardiovascular examination including auscultation for bruits and assessment of peripheral pulses is essential, as pulsatile tinnitus can be related to underlying vascular anomalies or abnormalities 1. Duplex ultrasound of the affected areas should be performed to evaluate for arterial abnormalities such as aneurysms or arteriovenous malformations. Additional testing may include an ECG to assess for cardiac arrhythmias, particularly if the sensations correlate with palpitations. If initial testing is unrevealing, consider advanced imaging such as CT angiography or MRI/MRA of the affected regions, as recommended by the American College of Radiology Appropriateness Criteria for pulsatile tinnitus 1. Neurological consultation may be warranted if symptoms persist without clear vascular etiology, as these sensations could represent atypical manifestations of peripheral neuropathy or sensory disturbances. The pulsating sensation in multiple body locations suggests a systemic process rather than a focal lesion, with differential diagnoses including:
• Arterial abnormalities
• Heightened awareness of normal pulsations (possibly anxiety-related)
• Medication side effects
• Early manifestations of a neurological disorder It is crucial to follow the guidelines for tinnitus evaluation, which emphasize the importance of a targeted history and physical examination, as well as audiologic examination in patients with hearing problems or unilateral persistent tinnitus 1.

From the Research

Differential Diagnosis

The patient presents with a pulsating, throbbing sensation behind the ear, forearm, and left thigh, which is intermittent and not painful. Based on the provided evidence, the following differential diagnoses can be considered:

• Peripheral Artery Disease (PAD) 2
• Neurophysiological correlates of throbbing sensation 3

Diagnostic Approach

To diagnose the patient's condition, the following diagnostic approaches can be considered:

• Magnetic Resonance Imaging (MRI) for evaluating peripheral artery disease 4
• Duplex ultrasound as a reliable alternative to CT angiography for treatment planning of peripheral artery disease 5
• CT angiography of peripheral arterial disease 6

Key Findings

The key findings from the provided evidence include:

• Peripheral artery disease affects more than 200 million people worldwide and is often an indicator of obstructive atherosclerotic disease involvement of cerebral and coronary vessels 2
• The throbbing quality of pain has a distinct neurophysiological correlate, which is unrelated to arterial pulsations 3
• MRI provides a safe and non-invasive method of evaluating peripheral artery disease, with and without using exogenous contrast agents 4
• Duplex ultrasound has good diagnostic concordance with CT angiography in the femoro-popliteal district, but is less accurate in the iliac arterial district 5
• CT angiography is increasingly used to evaluate patients with peripheral arterial disease, but has limitations, such as the need for contrast medium and radiation exposure 6