An extraordinary fenestration of the internal jugular vein: multidedector computed tomography findings

Abstract

164T he internal jugular vein (IJV) is the largest structure in the neck and drains the venous blood from the cranium, the facial region and the neck. It proceeds in the carotid sheath together with the common carotid artery before combining with the subclavian vein on the sternal side of the clavicle. The IJV is a significant landmark that is encountered during dissection of the cervical lymph nodes in oncological surgery, central venous catheter insertion, and interventional radiological procedures; familiarity with the probable anatomical variations of the IJV and those of its neighbouring structures is important (1-3). In this report, a male patient, in whom quite a large extraordinary fenestration was detected in the left IJV during multidetector computed tomography (MDCT), is presented in the light of MDCT findings and the literature. Case reportA 47-year-old male patient was presented to the emergency room after he was involved in a motor vehicular accident. He did not have any other complaints except pain in the cervical region. The patient was referred to the radiology department. Because physical examination revealed significant tenderness, pain and restricted motion of the neck, cervical vertebral injury and accompanying vertebral artery injury was suspected; therefore, 16-slice MDCT (Brilliance, Philips Medical Systems, Amsterdam, The Netherlands) imaging was performed after the adminstration of intravenous contrast medium. The scan parameters were 120 kV, 340 mAs, and 420 ms rotation time with a slice thickness of 1 mm and increments of 0.5 mm, using a detector collimation of 16×0.75 mm (pitch, 0.2). A hundred milliliters of nonionic, iodinated, low-osmolar contrast medium (Iomeron 350 mgI/ mL, Bracco, Milan, Italy) was injected through the antecubital vein at a rate of 5 mL/s. An automatic bolus-tracking method was used to optimize visualization. Multiplanar reconstruction and three-dimensional (3D) volume-rendered (VR) images were obtained from CT images performed in the axial plane at a separate workstation to display osseous structures. On coronal multiplanar reformation MDCT and 3D VR MDCT angiography images, a large fenestration with tortuous appearance was detected in the left IJV (Fig.). Because there were connections between the two vessels at the proximal and distal ends, we diagnosed this as an extraordinary fenestration of the left IJV. The IJV was equal in diameter above and below the fenestration. No additional abnormality of the other cervical vessels was identified. As the patient was found not to have any other pathologies except IJV fenestration on the examinations, he was followed-up for 24 hours in the emergency room and discharged after being informed about the vascular anomaly. ABSTRACT Fenestration of the internal jugular vein is a rare malformation. Herein, the authors describe an extreme fenestration of the left internal jugular vein. This anomaly was found incidentally in a 47-year-old male patient undergoing multidetector computed tomography (MDCT) imaging and MDCT angiogr...

Anatomical review of internal jugular vein cannulation

“…In 295 patients, who underwent surgical neck dissections, only 2 cases were reported to have fenestration [33]. An incidental finding of a fenestrated IJV was noted in another patient admitted following a motor vehicle accident [12].…”