Figure 11 - uploaded by Barton Branstetter
Content may be subject to copyright.
External jugular venous system in the lower neck to the external jugular terminus in the subclavian veins. (a) On a contrast-enhanced CT scan obtained at the level of the thyroid gland, the external jugular veins (solid arrows) are seen laterally. Note their reciprocal size relationship to the internal jugular veins (arrowheads). Note also the different degrees of venous enhancement: The larger left external jugular vein demonstrates soft-tissue attenuation, so that it could be mistaken for a lymph node on a single section. The left anterior jugular vein (open arrow) is seen crossing the sternocleidomastoid muscle posterolaterally and terminates in the left external jugular vein. Dashed arrows indicate duplicate right anterior jugular veins. (b) On a contrast-enhanced CT scan obtained at the level of the clavicles, the external jugular veins are seen terminating bilaterally in the subclavian veins (solid arrows). The internal jugular veins (arrowheads) are seen adjacent to the common carotid arteries (open arrows).
Source publication
The anatomy and imaging appearances of the veins of the head and neck can vary considerably, and normal veins may mimic disease processes at computed tomography (CT) and magnetic resonance (MR) imaging. On unenhanced CT scans, aberrant veins may be difficult to differentiate from lymph nodes or other pathologic conditions. Even at contrast material...
Citations
... During CT and MRI imaging, healthy veins may appear to be diseased. In this regard, a detailed understanding of normal as well as variant patterns of venous anatomy is important [3]. Variations of EJV are considered clinically relevant during the cut down approach as an alternative to cephalic vein [4]. ...
Awareness of the formation and termination of the head & neck's superficial vein, such as jugular veins, are imperative for anatomists, surgeons, and radiologists during interventional procedures. We report an uncommon variation in the formation of the retromandibular vein and external jugular vein (EJV) in an embalmed male cadaver's right side. The joining of the facial vein and superficial temporal vein within the parotid gland formed the retromandibular vein (RMV). The anterior division joined with the submental vein forming an anomalous venous trunk. The anomalous vein united with the EJV forming a common trunk in the lower third of the neck and terminated into the subclavian vein. We compared the available literature and justified the embryological development of this rare variation.
... The facial vein, common facial vein, and internal jugular vein are radiologically identifiable vascular structures. MR imaging is a frequently used non-invasive method to analyze the vasculature (12). Evaluating the venous vascular structures is possible with non-contrast MR imaging. ...
Aim:
Ventriculoatrial (VA) shunt applications are performed when applying ventriculoperitoneal shunt is not suitable. However, due to variations in the venous anatomy of the neck region and difficulties with venous vascular dissection, this procedure involves the risk of complications. This study aimed to develop an approach for atrial application of VA shunts after revealing the venous anatomy with facial and cervical anatomical dissections.
Material and methods:
Five cephalic cadavers were used in the study. Facial and cervical regions of the cephalic cadavers were examined with layer by layer anatomical dissection. Venous angiography and ultrasonography were performed to obtain additional data on the cervical venous vascular anatomy. Subsequently, we developed an approach for atrial catheter applications.
Results:
No anatomical variations were detected in the dissections. The common facial vein, which was formed by the facial vein and retromandibular vein, was observed to drain into the internal jugular vein. As a result of dissections and examinations, an incision approximately 2 cm below the mandible, extending from the projection of the submandibular notch to the trace of the angulus mandible, was considered adequate to expose the common facial vein for atrial catheter insertion.
Conclusion:
The approach described in our study is appropriate for the application of an atrial catheter for VA shunts. Revealing the venous anatomy with examinations contributes to the success of the operation.
... The pterygoid plexus is a venous plexus lying between the temporalis muscle and the lateral pterygoid muscle and is drained by the internal maxillary vein [27]. As any vascular structure, the pterygoid plexus enhances and stands out on contrast-enhanced Fig. 9 Venous malformation. ...
The differential diagnosis of a masticator space (MS) lesion is broad, owing in part to the multiple structures contained within such a small region. It is also because the MS is adjacent to many of the other deep spaces within the head and neck, which can act as gateways for disease spread. Therefore, emergency radiologists must be familiar with anatomy of the MS, as well as adjacent spaces in order to provide an accurate diagnosis to the referring clinician. This article illustrates the anatomy and common pathologies within the MS using a case-based multimodality approach. Common masticator space pathologies can be categorized into inflammatory/infectious, neoplastic, and vasoformative lesions. Important imaging features of MS lesions and patterns of disease spread will be discussed, with the aim of making this complex deep space more approachable in the emergent setting.
... As we know well that veins have a considerable variation in their size, shape as compared to other anatomical structures in body and may depend on position of body respiratory cycle and hydration status. [18] Thus these so called "stenosis" seem to be normal anatomical variations rather than any pathological entities (figure 5). These observations go against the theory of CCSVI which proposes stenotic lesions as the basis of the etiopathogenesis of multiple sclerosis. ...
... 26,31 EJV and AJV serve as collaterals and become prominent when the main cerebral venous drainage pathways (IJV and vertebral veins VV) are compromised. 32 The types and prevalence of human cerebral venous outflow patterns are analyzed by ultrasound US and magnetic resonance imaging MRI. 28,33,34 ...
Internal jugular veins (IJVs) are the largest veins in the neck and are considered the primary cerebral venous drain for the intracranial blood in supine position. Any reduction in their flow could potentially results an increase in cerebral blood volume and intracranial pressure (ICP). The right internal jugular vein communicates with the right atrium via the superior vena cava, in which a functional valve is located at the union of the internal jugular vein and the superior vena cava. The atrium aspiration is the main mechanism governing the rhythmic leaflets movement of internal jugular vein valve synchronizing with the cardiac cycle. Cardiac contractions and intrathoracic pressure changes are reflecting in Doppler spectrum of the internal jugular vein. The evaluation of the jugular venous pulse provides valuable information about cardiac hemodynamics and cardiac filling pressures. The normal jugular venous pulse wave consists of three positive waves, a, c, and v, and two negative waves, x and y. A normal jugular vein gradually reduces its longitudinal diameter, as described in anatomy books; it is possible to segment IJV into three different segments J3 to J1, as it proposed in ultrasound US studies and CT scan. In this review, the morphology and methodology of the cerebral venous drainage through IJV are presented.
... We hypothesized that a non-operator-dependent noninvasive method of assessing the patency of the IJVs and AZY, such as contrast-enhanced MR venography (CE-MRV), could confirm or refute the association of CCSVI with MS. Unlike Doppler ultrasound, this technique would allow us to assess not only the IJVs and the VVs, but also the AZY, the epidural venous plexuses and the deep cervical veins which may contribute to cerebrospinal venous outflow [14][15][16]. ...
... We found in our cohort of patients without MS, that it is very common to have asymmetrical internal jugular veins (75 %), with the right IJV being larger than the left. Venous calibre, however, can vary markedly due to hydration status, heart rate and function, amplitude and rate of respiration, postural changes and compression from adjacent structures [14,25]. Extrinsic compression from MRI neck coils, normal ligaments, muscles or swallowing can also explain the changes in the calibre of the veins [18]. ...
... CE-MRV lacks temporal resolution compared to Doppler ultrasound and has lower spatial resolution than catheter venography. In addition, it is affected by the nature of the veins which tend to change calibre and collapse due to a multitude of reasons [12,14,15,18,26]. Furthermore, our technique does not allow quantification of flow, and therefore the drainage efficacy of the IJVs cannot be assessed [21]. ...
Objective
To evaluate the extracranial venous anatomy with contrast-enhanced MR venogram (CE-MRV) in patients without multiple sclerosis (MS), and assess the prevalence of various venous anomalies such as asymmetry and stenosis in this population. Materials and methodsWe prospectively recruited 100 patients without MS, aged 18–60 years, referred for contrast-enhanced MRI. They underwent additional CE-MRV from skull base to mediastinum on a 3T scanner. Exclusion criteria included prior neck radiation, neck surgery, neck/mediastinal masses or significant cardiac or pulmonary disease. Two neuroradiologists independently evaluated the studies to document asymmetry and stenosis in the jugular veins and prominence of collateral veins. ResultsAsymmetry of internal jugular veins (IJVs) was found in 75 % of subjects. Both observers found stenosis in the IJVs with fair agreement. Most stenoses were located in the upper IJV segments. Asymmetrical vertebral veins and prominence of extracranial collateral veins, in particular the external jugular veins, was not uncommon. Conclusion
It is common to have stenoses and asymmetry of the IJVs as well as prominence of the collateral veins of the neck in patients without MS. These findings are in contrast to prior reports suggesting collateral venous drainage is rare except in MS patients. Key Points• The venous anatomy of the neck in patients without MS demonstrates multiple variants• Asymmetry and stenoses of the internal jugular veins are common• Collateral neck veins are not uncommon in patients without MS• These findings do not support the theory of chronic cerebrospinal venous insufficiency• MR venography is a useful imaging modality for assessing venous anatomy
... The internal jugular veins (IJVs), together with the vertebral veins, constitute the predominant extracranial pathways for the cerebral venous drainage [5,6]. The cerebrospinal venous system is characterized by a great anatomical variability and complex hemodynamics, which is not entirely comprehended [7]. ...
and Objectives
. The hypothesized link between extracranial venous abnormalities and some neurological disorders awoke interest in the investigation of the internal jugular veins (IJVs). However, different IJV cross-sectional area (CSA) values are currently reported in literature. In this study, we introduced a semiautomatic method to measure and normalize the CSA and the degree of circularity (Circ) of IJVs along their whole length.
Methods
. Thirty-six healthy subjects (31.22 ± 9.29 years) were recruited and the 2D time-of-flight magnetic resonance venography was acquired with a 1.5 T Siemens scanner. The IJV were segmented on an axial slice, the contours were propagated in 3D. Then, IJV CSA and Circ were computed between the first and the seventh cervical levels (C1–C7) and normalized among subjects. Inter- and intrarater repeatability were assessed.
Results
. IJV CSA and Circ were significantly different among cervical levels (
p
<
0.001
). A trend for side difference was observed for CSA (larger right IJV,
p
=
0.06
), but not for Circ (
p
=
0.5
). Excellent inter- and intrarater repeatability was obtained for all the measures.
Conclusion
. This study proposed a reliable semiautomatic method able to measure the IJV area and shape along C1–C7, and suitable for defining the normality thresholds for future clinical studies.
... The external jugular vein (EJV) and anterior jugular vein (AJV), compared with the IJV, are located superficially in the neck. They serve as collaterals and become prominent (enlarged lumen) when the main cerebral venous drainage pathways (IJV and VV) are compromised [92,93]. EJV is formed by the confluence of the posterior branch of the posterior facial vein and the posterior auricular vein. ...
The role of the extracranial venous system in the pathology of central nervous system (CNS) disorders and aging is largely unknown. It is acknowledged that the development of the venous system is subject to many variations and that these variations do not necessarily represent pathological findings. The idea has been changing with regards to the extracranial venous system.
A range of extracranial venous abnormalities have recently been reported, which could be classified as structural/morphological, hemodynamic/functional and those determined only by the composite criteria and use of multimodal imaging. The presence of these abnormalities usually disrupts normal blood flow and is associated with the development of prominent collateral circulation. The etiology of these abnormalities may be related to embryologic developmental arrest, aging or other comorbidities. Several CNS disorders have been linked to the presence and severity of jugular venous reflux. Another composite criteria-based vascular condition named chronic cerebrospinal venous insufficiency (CCSVI) was recently introduced. CCSVI is characterized by abnormalities of the main extracranial cerebrospinal venous outflow routes that may interfere with normal venous outflow.
Additional research is needed to better define the role of the extracranial venous system in relation to CNS disorders and aging. The use of endovascular treatment for the correction of these extracranial venous abnormalities should be discouraged, until potential benefit is demonstrated in properly-designed, blinded, randomized and controlled clinical trials.Please see related editorial: http://www.biomedcentral.com/1741-7015/11/259.
... It is a complex three-dimensional (3D) structure that is often asymmetric and represents significantly more variability than extra-cranial arterial anatomy. For example, unlike the carotid artery, the vascular wall of the internal jugular veins (IJVs) is much more flexible with a variable lumen diameter which can be influenced by postural change, respiration, cardiac function, hypovolemia and hydration status even by the pulsation of nearby arteries [5][6][7][8][9][10]. Even less is known about the main drainage routes of the spine, namely the azygous venous system and its pathophysiology. ...
... It is also less expensive and less time consuming. Examination is very short; hence, the image quality is hardly impaired by patient motion, putting it as a first choice in critically ill patients [5]. Many patients who are not candidates for MRV by virtue of pacemakers, other MRI incompatible devices or claustrophobia can be examined with CTV. ...
The extra-cranial venous system is complex and not well studied in comparison to the peripheral venous system. A newly proposed vascular condition, named chronic cerebrospinal venous insufficiency (CCSVI), described initially in patients with multiple sclerosis (MS) has triggered intense interest in better understanding of the role of extra-cranial venous anomalies and developmental variants. So far, there is no established diagnostic imaging modality, non-invasive or invasive, that can serve as the "gold standard" for detection of these venous anomalies. However, consensus guidelines and standardized imaging protocols are emerging. Most likely, a multimodal imaging approach will ultimately be the most comprehensive means for screening, diagnostic and monitoring purposes. Further research is needed to determine the spectrum of extra-cranial venous pathology and to compare the imaging findings with pathological examinations. The ability to define and reliably detect noninvasively these anomalies is an essential step toward establishing their incidence and prevalence. The role for these anomalies in causing significant hemodynamic consequences for the intra-cranial venous drainage in MS patients and other neurologic disorders, and in aging, remains unproven.
... Veins have a tendency to collapse and change their morphology and size depending on hydration status, position (gravitational variability), intrathoracic pressure (respiration, Valsalva), cardiac status, and compression from adjacent structures. [12][13][14][15] In particular, a blank jugular vein with a block of the flow due to a stenosing lesion of the outlet has reduced transmural pressure. In this condition, it becomes easily compressed by adjacent structures. ...
CCSVI was recently described in patients with MS. CCSVI is diagnosed noninvasively by Doppler sonography and invasively by catheter venography. We assessed the role of conventional MRV for the detection of IJV anomalies in patients with MS diagnosed with CCSVI and in healthy controls who underwent MRV and Doppler sonography examinations during 6 months.
Ten patients with MS underwent TOF, TRICKS, Doppler sonography, and catheter venography at baseline. They were treated at baseline with percutaneous angioplasty and re-evaluated 6 months' posttreatment with MRV and Doppler sonography. In addition, 6 healthy controls underwent a baseline and a 6-month follow-up evaluation by Doppler sonography and MRV.
At baseline, the sensitivity, specificity, PPV, and NPV of Doppler sonography for detecting IJV abnormalities relative to catheter venography in patients with MS were calculated, respectively, at 82%, 100%, 99%, and 95%. The figures were 99%, 33%, 33%, 99% for TOF and 99%, 39%, 35%, and 99% for TRICKS. Venous anomalies included the annulus, septum, membrane, and malformed valve. No agreement was found between TOF and catheter venography in 70% of patients with MS and between TRICKS and catheter venography in 60% of patients with MS. At follow-up, 50% of the patients with MS presented with abnormalities on Doppler sonography but only 30% were diagnosed with restenosis.
Conventional MRV has limited value for assessing IJV anomalies for both diagnostic and posttreatment purposes.
