Hemodynamics of the Internal Jugular Vein: An Ultrasonographic Study
Article Outline
Abstract
Objective
To establish a simple classification of internal jugular venous flow using ultrasonography.
Materials and Methods
We retrospectively analyzed the sonographic findings of 1600 consecutive patients who were referred to the neurosono-graphic laboratory. Abnormal jugular venous flow was classified into five groups: (A) markedly decreased flow velocity; (B) stasis and/or thrombus formation; (C) reversed flow; (D) increased turbulent flow; and (E) pulsa-tile turbulent flow. Groups A to C were categorized as slow flow groups and groups D and E as high flow groups.
Results
Abnormal jugular venous flow was found in 182 (11%) patients. A slow flow pattern (73%) comprised the majority of abnormalities. Eightynine percent of patients in the slow flow groups had abnormalities in the left internal jugular vein (IJV) and 92% of those in the high flow groups had abnormalities in the bilateral IJV. Incompetence of the jugular valve was the most common cause of slow flow in the IJV. Most of the increased turbulent flow was found in patients with hyperthyroidism and in pregnant women. Arteriovenous malformation and carotid-cavernous fistula were the causes of pulsatile turbulent jugular venous flow. Associated clinical symptoms occurred in only two (1.5%) patients (with a concomitant left IJV and left subclavian vein thrombosis) in the slow flow groups, and in 34 (68%) patients in the high flow groups.
Conclusion
Most of the abnormally decreased jugular venous flow occurred on the left side. Decreased venous flow or even thrombosis of one side of the IJV was usually asymptomatic. Increased jugular flow was associated with a physiological hyperemic state in cerebral hemodynamics. Increased awareness and angiographic studies are indicated in patients with pulsatile turbulent jugular venous flow because of a high correlation with intracranial arteriovenous shunting.
Keywords: Color-coded carotid duplex sonography , Internal jugular vein , Jugular venous flow , Ultrasonography
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References
- . The jugular vein tracing . Am Heart J . 1960;59:698–717
- . Effects of cardiopulmonary bypass on the jugular venous pulse . Am Heart J . 1977;94:262–264
- . Changes in jugular venous flow velocity after coronary artery bypass grafting . Am J Cardiol . 1989;63:725–729
- . Position of the internal jugular vein in children. A study of the anatomy using ultrasound . Paediatr Anesth . 1999;9:111–114
- . US-guided puncture of the internal vein: complications and anatomic considerations . J Vasc Interv Radiol . 1998;9:333–338
- . Internal jugular and subclavian vein thrombosis caused by central venous catheters. Evaluation using Doppler blood flow imaging . J Ultrasound Med . 1988;7:629–636
- . Sonographic diagnosis of subclavian and internal jugular vein thrombosis . J Ultrasound Med . 1987;6:577–587
- . Complications of central venous catheterization . AJR Am J Roentgenol . 1979;133:467–476
- . Superior vena cava syndrome: a complication of transvenous pacemaker implantation . Radiology . 1978;126:377–378
- . Anatomical variations of internal jugular vein location: impact on central venous access . Crit Care Med . 1991;19:1516–1519
- . Relationship between Trendelenburg tilt and internal jugular vein diameter . Emerg Med J . 2005;22:867–868
- . Internal jugular vein thrombosis due to distant malignancies: two case reports and literature review . J Laryngol Otol . 2008;122:318–320
- . Ultrasonography of the internal jugular vein in patients with dyspnea without jugular venous distention on physical examination . Ann Emerg Med . 2004;44:160–168
- . The internal jugular vein valve may have a significant role in the prevention of venous reflux: evidence from live and cadaveric human subjects . Clin Physiol Funct Imaging . 2002;22:202–205
- Jugular valve incompetence: a study using air contrast ultrasonography on a general population . J Ultrasound Med . 2002;21:747–751
- . Disturbance of venous flow patterns in patients with transient global amnesia . Lancet . 2000;356:1982–1984
- . Detection of intracranial venous reflux in patients of transient global amnesia . Neurology . 2006;66:1873–1877
- Reflux of jugular and retrobulbar venous flow in transient monocular blindness . Ann Neurol . 2008;63:247–253
- . Cough headache and thoracic inlet valvular competence in uremia . Eur Neurol . 2005;53:78–80
- . Incompetence of internal jugular valve in patients with primary exertional headache: a risk factor? . Cephalalgia . 2008;28:182–185
- . Carotid duplex and transcranial color-coded sonography in evaluation of carotid-cavernous sinus fistulas . J Ultrasound Med . 1994;13:557–564
- Colour Doppler imaging for diagnosis of intracranial hypotension . Lancet . 1999;354:826–829
- Natural course of unoperated intracranial arteriovenous malformations: study of 50 cases . J Neurosurg . 1989;71:805–809
PII: S1016-3190(09)60062-8
doi:10.1016/S1016-3190(09)60062-8
© 2009 Buddhist Compassion Relief Tzu Chi Foundation. Published by Elsevier Inc. All rights reserved.
