To discuss physiological changes brought about by the Valsalva maneuver and their implications in diagnostic radiology. To discuss modifications and alternatives to the technique. To discuss the difference between Valsalva maneuver and abdominal straining. To discuss its potential side effects and complications.

The Valsalva maneuver is credited to Antonio Maria Valsalva(1666-1723), an Italian anatomist, as a technique for expelling pus from ear by expiration against a closed nose and mouth,through an open glottis.[1] In present medical terminology, Valsalva maneuver is defined as a moderately forceful act of expiration against a closed glottis(Fig.1). In spite of technological advances, it has remained a reliable provocative maneuver to increase intra-cranial, intra-pharyngeal, intra-thoracic and intra-abdominal pressure in the detection andgrading of various pathologies.

Besides its age-old uses, there have been innovative successful single case or short case series studies to demonstrate its role in lesser known pathological conditions. HEAD AND NECK CSF leaks-In CT cisternography, after obtaining initial pre-cisternogram images and confirming cranial flow of contrast material, the patient is asked to perform Valsalva maneuver that can exacerbate the leak and repeat CT is performed.[2]All methods of cisternography—radionuclide, CT, and MR—provide improved or optimal CSF fistula detection when the fistula is active and when a Valsalva maneuver is...

The use of Valsalva maneuver and its modifications can obtain significant diagnostic clarity in various pathologies if the patient is co-operative and adequately explained.The concept of Valsalva maneuver has to be thoroughly understood and has to be differentiated from Valsalva like- maneuvers in order to avoid confounding results. Patients should also bewarned against its inadvertant performance where it can lead to artifacts and complications.

[1]Jellinek EH. The Valsalva manoeuvre and Antonio Valsalva (1666–1723). Journal of the Royal Society of Medicine. 2006 Sep;99(9):448-51. [2]Lloyd KM, DelGaudio JM, Hudgins PA. Imaging of skull base cerebrospinal fluid leaks in adults. Radiology. 2008 Sep;248(3):725-36. [3]Haldar R, Khandelwal A, Gupta D, Srivastava S, Rastogi A, Singh PK. Valsalva maneuver: Its implications in clinical neurosurgery. Neurology India. 2016 Nov 1;64(6):1276. [4]Mo Y, Zhuo S, Tian L, Zhou J, Lu G, Zhang Y, Liu L. Functional MRI of the Eustachian tubes in patients with nasopharyngeal carcinoma:...