High riding jugular bulb: prevalence and significance in asymptomatic children

Abstract

Background High riding jugular bulb (HJB) is a vascular abnormality characterized by the higher-than-normal location of the jugular bulb. Purpose To evaluate the frequency of HJB among children who underwent cranial computed tomography (CT) mostly because of head trauma. Material and Methods Patient demographics such as age, sex, indication of cranial CT, diameters of the right and left JB, and presence and laterality of HJB were recorded and analyzed. Patients were grouped as with HJB and without HJB; the variables were compared between these two groups. Patients were also divided into age groups as 0–1 month, 1–12 months, 12–24 months, and >24 months and the findings. The Shapiro–Wilk test, histograms, and Q-Q, Mann–Whitney U-test, Pearson's chi-square test, and Fisher's exact test were used. Results In total, CT images of 194 patients (388 JBs) were evaluated. Overall, 42.8% of children had HJB. Only three children had bilateral HJB. Of all JBs, 22.2% were high riding. Children who did not have HJB were significantly younger compared to children with HJB ( P = 0.029). The median diameter of the HJB was significantly higher in children with HJB compared to children without HJB on both sides ( P < 0.001). Among newborns, none had HJB. In infants, 11 (30.6%) had HJB; 35 (46.7%) and 37 (50.0%) children aged >12–24 months and >24 months had HJB, respectively. Conclusion A jugular bulb could be identified in all age groups, including newborns. The earliest age of HJB detection was eight months. Overall, 42% of the patients had HJB, which increased by age.

Bilateral high-riding jugular bulb associated with a jugular diverticulum and dehiscence of the mastoid cells and Trautmann’s triangle

“…Aksoy et al found, in their series, that 53% of children with HRJB were younger than two years, while 86% of them were older than 12 months. The earliest case they found was eight-month-old [1]. Such observations suggest the HRJB may be congenital, or it develops early.…”

“…Okudera et al reported the JB does not appear before two years old [1,9,10]. They studied aborted fetuses and children up to six years and speculated that, during the fetal period and rst two years, bony and cartilaginous structures surrounding the JB prevent its development [1].…”

“…Okudera et al reported the JB does not appear before two years old [1,9,10]. They studied aborted fetuses and children up to six years and speculated that, during the fetal period and rst two years, bony and cartilaginous structures surrounding the JB prevent its development [1]. From the age of two, the standing posture provokes negative pulses in the cranial venous circulation enlarging the IJV-SS junction, forming the JB, and excavating the jugular fossa [1,2].…”

“…The JB is the dilated venous junction that connects the SS to the IJV [2,5,10], close to several anatomic structures such as the middle and inner ears, and some cranial nerves [4,5]. The HRJB represents a JBlocation abnormality [1] that can still be asymptomatic or provoke hearing loss, vertigo, pulsatile tinnitus, or bleeding during ear surgery [9,10]. In fact, the surgeon must check for this condition on clinical and radiological exams to keep the patient safe.…”

Wave In in auditory brainstem response suggests a high possibility of a high jugular bulb

“…Reportedly, the incidence of HJB ranges from 6% to 20% in patients undergoing computed tomography (CT) of the temporal bone for any reason (8,9). A recent retrospective study shows a prevailing rate of 42% for HJB (predominantly unilateral) among 194 children who underwent cranial CT primarily due to head trauma (10). Awareness of vascular abnormalities is beneficial in minimizing clinical complications during otologic surgery (11).…”