Volume 21, Issue 4, Pages 317-322 (December 2009)

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ABSTRACT

ABSTRACT + REFS

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Hemodynamics of the Internal Jugular Vein: An Ultrasonographic Study

Received 22 May 2009; received in revised form 23 July 2009; accepted 16 November 2009.

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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Article Outline

• Abstract

• References

• Copyright

References

1. 1 Harman H . The jugular vein tracing . Am Heart J . 1960;59:698–717 . MEDLINE | CrossRef

2. 2 Wann LS , Morris SN , Tavel ME . Effects of cardiopulmonary bypass on the jugular venous pulse . Am Heart J . 1977;94:262–264 . MEDLINE | CrossRef

3. 3 Ranganathan N , Sivaciyan V , Pryszlak M , Freeman MR . Changes in jugular venous flow velocity after coronary artery bypass grafting . Am J Cardiol . 1989;63:725–729 . MEDLINE | CrossRef

4. 4 Mallinson C , Bennett J , Hodgson P , Petros AJ . Position of the internal jugular vein in children. A study of the anatomy using ultrasound . Paediatr Anesth . 1999;9:111–114 .

5. 5 Gordon AC , Saliken JC , Johns D , Owen R , Gray RR . US-guided puncture of the internal vein: complications and anatomic considerations . J Vasc Interv Radiol . 1998;9:333–338 . Abstract | Full-Text PDF (1642 KB) | CrossRef

6. 6 Hubsch PJ , Stiglbauer RL , Schwaighofer BW , Kainberger FM , Barton PP . Internal jugular and subclavian vein thrombosis caused by central venous catheters. Evaluation using Doppler blood flow imaging . J Ultrasound Med . 1988;7:629–636 . MEDLINE

7. 7 Weissleder R , Elizondo G , Stark DD . Sonographic diagnosis of subclavian and internal jugular vein thrombosis . J Ultrasound Med . 1987;6:577–587 . MEDLINE

8. 8 Mitchell SE , Clark RA . Complications of central venous catheterization . AJR Am J Roentgenol . 1979;133:467–476 .

9. 9 Chamorro H , Rao G , Wholey MH . Superior vena cava syndrome: a complication of transvenous pacemaker implantation . Radiology . 1978;126:377–378 . MEDLINE

10. 10 Denys BG , Uretsky BF . Anatomical variations of internal jugular vein location: impact on central venous access . Crit Care Med . 1991;19:1516–1519 . MEDLINE | CrossRef

11. 11 Clenaghan S , McLaughlin RE , Martyn C , McGovern S , Boera J . Relationship between Trendelenburg tilt and internal jugular vein diameter . Emerg Med J . 2005;22:867–868 . CrossRef

12. 12 Pata YS , Unal M , Gulhan S . Internal jugular vein thrombosis due to distant malignancies: two case reports and literature review . J Laryngol Otol . 2008;122:318–320 .

13. 13 Jang T , Aubin C , Naunheim R , Char D . Ultrasonography of the internal jugular vein in patients with dyspnea without jugular venous distention on physical examination . Ann Emerg Med . 2004;44:160–168 . Abstract | Full Text | Full-Text PDF (343 KB) | CrossRef

14. 14 Silva MA , Deen KI , Fernando DJ , Sheriffdeen AH . 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 . MEDLINE

15. 15 Akkawi NM , Agosti C , Borroni B , et al. Jugular valve incompetence: a study using air contrast ultrasonography on a general population . J Ultrasound Med . 2002;21:747–751 . MEDLINE

16. 16 Sander D , Winbeck K , Etgen T , Knapp R , Klingelhofer J , Conrad B . Disturbance of venous flow patterns in patients with transient global amnesia . Lancet . 2000;356:1982–1984 . Abstract | Full Text | Full-Text PDF (72 KB) | CrossRef

17. 17 Chung CP , Hsu HY , Chao AC , Chang FC , Sheng WY , Hu HH . Detection of intracranial venous reflux in patients of transient global amnesia . Neurology . 2006;66:1873–1877 . CrossRef

18. 18 Hsu HY , Chao AC , Chen YY , et al. Reflux of jugular and retrobulbar venous flow in transient monocular blindness . Ann Neurol . 2008;63:247–253 . CrossRef

19. 19 Chuang YM , Hu HH . Cough headache and thoracic inlet valvular competence in uremia . Eur Neurol . 2005;53:78–80 . MEDLINE | CrossRef

20. 20 Doepp F , Valdueza JM , Schreiber SJ . Incompetence of internal jugular valve in patients with primary exertional headache: a risk factor? . Cephalalgia . 2008;28:182–185 .

21. 21 Lin SK , Ryu SJ , Chu NS . Carotid duplex and transcranial color-coded sonography in evaluation of carotid-cavernous sinus fistulas . J Ultrasound Med . 1994;13:557–564 . MEDLINE

22. 22 Chen CC , Luo CL , Wang SJ , et al. Colour Doppler imaging for diagnosis of intracranial hypotension . Lancet . 1999;354:826–829 . Abstract | Full Text | Full-Text PDF (122 KB) | CrossRef

23. 23 Itoyama Y , Uemura S , Ushio Y , Kuratsu JI , et al. Natural course of unoperated intracranial arteriovenous malformations: study of 50 cases . J Neurosurg . 1989;71:805–809 . MEDLINE | CrossRef

a Stroke Center and Department of Neurology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan

b School of Medicine, Tzu Chi University, Hualien, Taiwan

c Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan

d College of Medicine, Chang Gung University, Taoyuan, Taiwan

Corresponding author. Department of Neurology, Buddhist Tzu Chi General Hospital, 289, Jian-Guo Road, Xindian, Taipei, Taiwan

PII: S1016-3190(09)60062-8

doi:10.1016/S1016-3190(09)60062-8

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