Management of an incidental finding of right internal jugular vein agenesis

Abstract

A 43-year-old woman was referred to the University of Hong Kong-Shenzhen Hospital in August 2016 with a 10-year history of hepatolithiasis. Computed tomography (CT) of the abdomen demonstrated multiple stones in the right posterior portion of the liver, the common biliary duct, and the gallbladder. Dilatation and inflammation of both intra-and extra-hepatic ducts were apparent and an elective right hepatectomy along with a Roux-en-Y hepaticojejunostomy was arranged. Preoperative physical examination was normal apart from hypertension (168/105 mm Hg). Laboratory tests revealed a microcytic, hypochromic anaemia (haemoglobin, 97 g/L), hyperuricaemia, and mildly elevated alkaline phosphatase. Liver/renal function, clotting profile, chest X-ray, and electrocardiogram were all normal. General anaesthesia was induced intravenously with propofol and remifentanil using a target-controlled infusion (Marsh model) under the guidance of the Bispectral Index monitoring system (Covidien, Boulder [CO], US). Tracheal intubation was performed following administration of rocuronium and anaesthesia maintained intravenously with intermittent positive pressure ventilation in oxygen and air. The patient was positioned for right internal jugular vein (IJV) cannulation.Pre-insertion sonographic evaluation of the right cervical region (SonoSite M-Turbo, Bothell [WA], US) using a linear, high-frequency transducer (HFL38, 6-13 MHz) revealed only a single pulsatile vessel that was non-compressible and suggestive of the right carotid artery. The characteristic pulsatile blood flow was confirmed by Doppler. There was no evidence of the right IJV despite repositioning of the patient's head, use of minimal pressure on the probe with colour flow mapping, and the application of Valsalva manoeuvre. Ultrasonography of the left side showed normal anatomy with good size of IJV. Following a brief discussion, the consultant anaesthetist and the surgeon decided to proceed with surgery without a central venous catheter. At the end of liver resection, the patient began to develop hypotension that was marginally responsive to fluid

Neck cystic haemangiolymphangioma associated with congenital agenesis of the internal jugular vein in a term newborn

“…Moreover, the agenesis of the right internal jugular vein is a definitely rare condition, though there are some reports of this rare anomaly . There is no knowledge of further implications and possible complications due to this condition, even in the adult age, but in our case the dilatation of the superior vena cava and of the innominate veins (as a probable compensatory mechanism) were the only prenatal findings.…”

Persistent headaches sometimes concern incidental findings of rare internal jugular vein agenesis rare case in Bangladesh: A case report

“…In a patient with congenital agenesis of the IJV, impairment of the alternate pathways of vascular supply from the cranial cavity can have catastrophic repercussions. Embryological developmental abnormalities cause vascular anomalies in the head and neck region, which can persist asymptomatically (7).…”

Anatomical review of internal jugular vein cannulation

“…It may result from abnormally formed channels lined by quiescent endothelium [59]. Four cases of agenesis of the right IJV were detected during attempted cannulations and all of them were cannulated into the left IJV or the axillary vein [4,61,79,96]. A 55-year-old patient showed right IJV agenesis, and a detailed study on venous anatomy revealed left IJV phlebectasia and collateral channel that drained the right IJV into the left IJV [43].…”

“…IJV cannulation using the landmark technique in a patient with an absent IJV may be related to a higher incidence of complications such as arterial puncture and pneumothorax [96]. Detecting variations before the procedure was recommended to allow a preoperative discussion between the patient and surgeon on alternative cannulation sites and monitoring strategies [61]. Although a meta-analysis reported that real-time USG-guided IJV placement was not beneficial, USG imaging prior to IJV insertion was found to lower cannulation failure and injury to the carotid artery [107].…”