Drainage of External Jugular Vein into an Unusually Wider Internal Jugular Vein: A Rare Case Report.

The superficial veins are of utmost importanceclinically for cannulation, which is required fordiagnostic purposes and intravenous therapy. One suchsuperficial vein in the neck region is the externaljugular vein. The other vein, deeper in this region, isthe internal jugular vein. The internal jugular vein iscommonly used for central venous catheterization.Anomaly in the course and termination of bothexternal and Internal Jugular Veins (IJV) are critical asthey serve as an important route/site to perform variousdiagnostic or therapeutic procedures. Present caseshows a rare variation of termination of the rightexternal jugular vein into an unusually wider IJV.Variation as described in the present case, if found,would ease the clinicians' task to approach a lessaccessible IJV. Ultrasound-guided venouscatheterization would serve as a guide to perform theprocedure with ease and also to be familiar with suchvariations existing in the venous channels

Hemangioma de veia jugular externa: relato de caso / External jugular vein hemangioma: case report

Hemangioma é um tumor frequente, geralmente diagnosticado em crianças, constituindo quase 10% das neoplasias benignas. Um hemangioma com crescimento na parede de um vaso é extremamente raro, e deve ser diferenciado de outras malformações vasculares de mesma origem. Apresentamos um caso raro de hemangioma de veia jugular externa e discutimos sua propedêutica e manejo

Hemangioma is a common tumor, normally diagnosed in children, and accounting for almost 10% of benign neoplasms. A hemangioma arising from the wall of a vessel is rare, and must be differentiated from other vascular malformations of the same origin. We report a rare case of a hemangioma arising from the wall of an external jugular vein and discuss diagnostic work-up and management

A Case of Intravenous Pyogenic Granuloma Originating in the External Jugular Vein / 대한이비인후과학회지

Intravenous pyogenic granuloma (IVPG), also known as intravenous lobular capillary hemangioma, is an extremely rare form of vascular tumor which derives from the lumen of a vein of the head and neck and upper extremities. The treatment of choice is complete local excision of a small portion of the vein. Since first report in 1979, IVPG has been reported in no more than 60 reports abroad. To our knowledge, IVPG originating in the external jugular vein has never been reported in Korea but has important clinical implication. Accurate preoperative diagnosis of neck mass originating in jugular vein is important to plan operative procedures to avoid vascular injury, excessive bleeding, or incomplete excision. Preoperative radiologic examinations such as ultrasonography, computed tomography are useful as first-line diagnostic tools for differential diagnosis of movable neck mass. With a review of literature, the author reports a case of IVPG arising from the left external jugular vein in a 31-year-old male who complained about a palpable neck mass. This patient was successfully managed by ligation and excision of the vein without any complication and no recurrence was found after 6 months.

Variations of the external and internal jugular veins: a fetal study / Variaciones de las venas yugulares externas e internas: estudio fetal

SUMMARY: The external jugular vein (EJV) is formed by the union of the posterior division of the retromandibular vein and posterior auricular vein, while the internal jugular vein (IJV) is a continuation of the sigmoid sinus. A number of variations in the formation, lengths and drainage patterns of EJV and IJV have been documented in adults, however there is a paucity of literature regarding fetal studies. This study aimed to highlight variation patterns of external and internal jugular veins in 40 fetuses (n=80). This study included the bilaterally dissection of the neck region in 40 fetuses between the gestational ages of 15-28 weeks at the University of KwaZulu-Natal as per Grants Dissector. This study observed three variations in the pattern of the EJV and IJV. With regard to the EJV, duplication occurred on the sternocleidomastoid muscle in 4 % of the specimens sampled in this study, which concurred to a study conducted by Olabu et al. (2015) in a Kenyan sample. The "Y-shaped" IJV occurred in 1 % of the specimens, however the "Y-shaped" IJV gave off a tributary to the EJV in 3 % of the specimens sampled in this study. Lalwani et al. (2006) stated a rare venous communication between the EJV and IJV. The knowledge of the variable patterns of the external and internal jugular veins are important to clinicians performing micro-vascular surgeries in head and neck region.

RESUMEN: La vena yugular externa (VYE) está formada por la unión de la división posterior de la vena retromandibular y la vena auricular posterior, mientras que la vena yugular interna (VYI) es una continuación del seno sigmoideo. En adultos se han documentado una serie de variaciones en la formación, las longitudes y los patrones de drenaje de la VYE y la VYI, sin embargo hay escasa literatura con respecto a estudios fetales. Este estudio tuvo como objetivo destacar los patrones de variación de las venas yugulares externa e interna en 40 fetos (n = 80). El estudio incluyó la disección bilateral de la región del cuello en 40 fetos de edades gestacionales entre 15-28 semanas en la Universidad de KwaZuluNatal. Se observó tres variaciones en el patrón de la VYE y la VYI. Con respecto a la VYE, se produjo duplicación en el músculo esternocleidomastoideo en el 4 % de los especímenes, lo que coincidió con un estudio realizado por Olabu et al. en una muestra keniana. La VYI en "Y" se observó en el 1 % de los especímenes, y otorgó un afluente a la VYE en el 3 % de los especímenes muestreados en este estudio. Lalwani et al. describió una rara comunicación venosa entre la VYE y la VYI. El conocimiento de los patrones variables de las venas yugulares externa e interna es importante para los médicos que realizan cirugías microvasculares en la región de cabeza y cuello.

The effect of early external jugular vein access for fluid resuscitation on prognosis of sepsis patients / 中华急诊医学杂志

Objective To evaluate the effect of fluid resuscitation with early external jugular vein access on prognosis of sepsis patients.Methods One hundred and twenty patients with sepsis,admitted to emergency intensive care unit (EICU) and the general intensive care units (ICU) were randomly divided into two groups,external jugular vein group (n=60) and deep-vein group (e.g.internal jugular vein,subclavian vein,femoral vein,n=60).The time elapsed from admission to initial application of norepinephrine,the time required for getting the early goal directed therapy (EGDT) after standard procedure,the length of time needed for subsequent use of vasoactive agents during the entire course of resuscitation serum lactate level at3 h and 6 h after resuscitation,lactate clearance rate,SOFA scores were documented.The mortality rates of 14 days and 28 days were observed after treatment.Results Compared with deep vein access,the time elapsed from admission to the initial application of norepinephrine and the time required for getting EGDT were significantly shortened [(20.78±5.03) vs.(6.12±2.58),P＜0.01;(6.15±2.03)vs.(5.35±2.21),P＜0.05],and the serum level of lactate was significantly decreased[(6.88±1.71)vs.(6.28±1.51),P＜0.05] at 3 h after resuscitation,and lactate clearance rate in percentage was significantly increased at 3 h after resuscitation,and SOFA at 6 h was decreased[(25.8±9.2) vs.(31.2±13.3),P＜0.05],and SOFA at 6 h was distinctly reduced [(5.78±1.19) vs.(5.38±0.96),P＜0.05],and.the mortality rates of 14 days decreased significantly in the external jugular vein group(33.3％ vs.16.7％,P＜0.05).Conclusions Early external jugular vein access can more significantly save time,improve the effect of fluid resuscitation,promote recovery of important organ.It is helpful for improving prognosis in sepsis patients.

Variaciones anatómicas en el drenaje venoso del cuello / Anatomical variations in the venous drainage of the neck

Resumen Las venas superficiales, especialmente la vena yugular externa, son cada vez más utilizadas para canalización o procedimientos diagnósticos, terapias intravenosas, nutrición parenteral en pacientes debilitados. Las variaciones en el drenaje venoso de la cabeza y cuello son importantes no solamente para los anatomistas y radiólogos, sino también para los cirujanos. Durante una disección de rutina en el Laboratorio de Morfología de la Universidad de Pamplona en un cadáver masculino de 75 años de edad, se encontraron variaciones anatómicas e inusuales patrones de drenaje en la región de cara y cuello, las cuales fueron cuidadosamente disecadas y los detalles morfológicos fueron fotografiados; esas variaciones consistían en: ausencia unilateral de vena yugular externa. La vena lingual, la vena infrahioidea y la vena tiroidea superior tenían conexiones venosas transversas que drenaban en un arco venoso localizado entre la arteria carótida común y la arteria tiroidea superior. Este arco venoso drenaba hacia arriba en la vena facial común y hacia abajo en la vena yugular interna. El conocimiento de las variaciones anatómicas y morfológicas en las venas de cabeza y cuello es esencial para llevar a cabo procedimientos quirúrgicos exitosos en estas regiones.

Abstract The superficial veins, especially the external jugular vein are increasingly used for cannulation or diagnostic procedures, intravenous therapy, parenteral nutrition in debilitated patients. Variations in the venous drainage of the head and neck are important not only for anatomists and radiologists but also for surgeons. During routine dissection in the Laboratory of Morphology, University of Pamplona in a 75 year-old male cadaver in the region face and neck anatomical variations and unusual drainage patterns were found, which were dissected carefully and morphological details were photographed; these variations consisted of unilateral absence of external jugular vein. The lingual vein, the infrahyoid vein and the superior thyroid vein had transverse venous connections that drained into a venous arch located between the common carotid artery and the superior thyroid artery. This draining venous arch upward in the common facial vein and down into the internal jugular vein. Knowledge of the anatomical and morphological variations in the veins of the head and neck is essential to carry out successful surgical procedures in these regions.

A rare case of persistent jugulocephalic vein and its clinical implication / 대한해부학회지

Persistence of jugulocephalic vein is one of the extremely rare variations of the cephalic vein. Knowledge of such a variation is of utmost importance to orthopedic surgeons while treating the fractures of the clavicle, head and neck surgeons, during surgery of the lower part of neck, for cardiothoracic surgeons and radiologists during catheterization and cardiac device placement. We report the persistent jugulocephalic vein in an adult male cadaver, observed during the routine dissection classes. The right cephalic vein ascended upwards, superficial to the lateral part of the clavicle and terminated into the external jugular vein. It also gave a communicating branch to the axillary vein below the clavicle. We discuss the embryological and clinical importance of this rare variation.

Malposition of central venous catheter in the jugular venous arch via external jugular vein: a case report / 대한마취과학회지

The central venous cannulation is commonly performed in the operating rooms and intensive care units for various purposes. Although the central venous catheter (CVC) is used in many ways, the malpositioning of the CVC is often associated with serious complications. We report a case of an unexpected malposition of a CVC in the jugular venous arch via external jugular vein.

An Unusual Termination of Facial Vein and Anterior Division of Retromandibular Vein into External Jugular Vein: A Case Report

Facial vein, being the largest vein of the face forms the common facial vein after joining with the anterior division of retromandibular vein below the angle of the mandible. Usually, it drains into the internal jugular vein. During routine dissection of head and neck region of a male cadaver, aged approximately 50 years, an unusual pattern in the termination of veins on the left side of the neck was observed. The formation, course and termination of external jugular vein were normal. The anterior division of retromandibular vein joined with external jugular vein about 5 cm above the clavicle and the facial vein opened into the external jugular vein about 2.5 cm above the clavicle. In addition, there was a thin venous communication between anterior division of retromandibular vein and external jugular vein. The superficial veins of the neck are often used for cannulation; either for intravenous infusion or for central venous pressure monitoring. Furthermore, these venous segments are used as a patch for carotid endarterectomies. Hence, a thorough knowledge of the normal anatomy and their variations may be useful for performing these procedures.

Absence of retromandibular vein associated with atypical formation of external jugular vein in the parotid region / 대한해부학회지

Veins of the head and neck exhibiting anatomical variations or malformations are clinically significant. Anatomical variation in the external jugular vein is very common. However, anatomical variation in the retromandibular vein is rare. In this paper, we report a rare case of complete absence of the retromandibular vein. In the absence of the retromandibular vein, the maxillary vein divided into anterior and posterior divisions. The posterior division joined the superficial temporal vein to form an atypical external jugular vein, and the anterior division joined the facial vein to form an anonymous vein. In clinical practice, radiologists and surgeons use the retromandibular vein as a guide to expose the branches of the facial nerve during superficial parotidectomy. Therefore, absence of the retromandibular vein is a hurdle during this procedure and may affect the venous drainage pattern from the head and neck.

Absence of retromandibular vein associated with atypical formation of external jugular vein in the parotid region / 대한해부학회지

Veins of the head and neck exhibiting anatomical variations or malformations are clinically significant. Anatomical variation in the external jugular vein is very common. However, anatomical variation in the retromandibular vein is rare. In this paper, we report a rare case of complete absence of the retromandibular vein. In the absence of the retromandibular vein, the maxillary vein divided into anterior and posterior divisions. The posterior division joined the superficial temporal vein to form an atypical external jugular vein, and the anterior division joined the facial vein to form an anonymous vein. In clinical practice, radiologists and surgeons use the retromandibular vein as a guide to expose the branches of the facial nerve during superficial parotidectomy. Therefore, absence of the retromandibular vein is a hurdle during this procedure and may affect the venous drainage pattern from the head and neck.

A case of unilateral fenestration and duplication of the external jugular vein / Un caso de fenestración unilateral y duplicación de la vena yugular externa

The external jugular vein is increasingly being utilized as the recipient vein in head and neck free tissue transfers, and for cannulation in order to conduct diagnostic procedures or intravenous therapies. The variations in the patterns of its course, and knowledge of them, are therefore important. We report on a unique and previously non-described unilateral fenestration and duplication of the external jugular vein found during the neck dissection of a 77-year-old female cadaver. Embryological evaluation and clinical implications of the anomaly are described. Clinicians and surgeons performing neck vascular or reconstructive surgery should be aware of this variation of the external jugular vein in the hope of preventing inadvertent injury.

La vena yugular externa se está utilizando cada vez como vena receptora en la transferencias de tejidos libres de cabeza y cuello, y para canulización en procedimientos de diagnóstico o terapias intravenosas. Las variaciones en los patrones de su curso, y el conocimiento de los mismos son relevantes. Se reporta una fenestración unilateral, no descrita previamente, y la duplicación de la vena yugular externa encontrada durante la disección del cadáver de una mujer de 77 años de edad. Se hace una evaluación embriológica y las implicaciones clínicas de esta anomalía. Los médicos y cirujanos que realizan cirugía vascular o reconstructiva de cuello deben tener en cuenta esta variación de la vena yugular externa con el fin de prevenir lesiones accidentales.

Two rare anatomical variations of external jugular vein: an embryological overview / Dos raras variaciones anatómicas de la vena yugular externa: una visión embriológica

Human anatomy is an ocean of unending variations and its mysteries are being unravelled since ages. Knowledge of variations in the superficial veins of head and neck is essential to carry out successful surgical procedures. During routine dissection of head and neck of two middle aged male cadavers, in the Department of Anatomy, Calcutta National Medical College, Kolkata, India, we came out with some interesting venous architecture. The retromandibular vein on the left side of both the cadavers was found to be undivided and joined with the facial vein in the neck at an acute angle to form a common venous trunk at variable distances from the angle of the mandible. That trunk ultimately drained into the left subclavian vein. This might be the result of disappearance of the cephalic part of the external jugular vein and formation of an additional communication between common facial vein and the external jugular vein in foetal life. In one case, we also came across an extra transverse communication between that common trunk and the internal jugular vein. A detail of those cases with embryological explanation is attempted...

La anatomía humana tiene un sin fin de variaciones y sus misterios se han develado desde el inicio de los tiempos. El conocimiento de las variaciones anatómicas de las venas superficiales de la cabeza y del cuello es fundamental para llevar a cabo con éxito los procedimientos quirúrgicos. Durante una disección de rutina de cabeza y cuello encontramos una arquitectura venosa interesante en dos cadáveres de hombres de mediana edad en el Departamento de Anatomía de la Facultad de Medicina Nacional Calcuta, Calcuta, India. En el lado izquierdo del cuello de ambos cadáveres, la vena retromandibular no se encontraba dividida, y se unía a la vena facial en un ángulo agudo, para formar un tronco venoso común a una distancia variable desde el ángulo de la mandíbula. Ese tronco finalmente drenaba en la vena subclavia izquierda. Esto podría ser el resultado de la desaparición de la parte cefálica de la vena yugular externa y la formación de una comunicación adicional entre la vena facial común y la vena yugular externa en la vida fetal. En un caso, también se encontró con una comunicación adicional transversal entre ese tronco común y la vena yugular interna. Se realiza una descripción en detalle de los casos junto a una explicación embriológica...

Undivided Retromandibular Vein Continuing As External Jugular Vein With Facial Vein Draining Into It : An Anatomical Variation.

Despite the fact that the blueprint of the whole body is unravelled, faultlessly during the growth and development of an animal; but amazingly variations do occur. During routine dissection of head and neck in a middle aged cadaver in the Post Graduate Department of Anatomy of this medical college, we found variation in the formation of external jugular vein on both sides, which was formed by the continuation of undivided trunk of retromandibular vein. The facial vein and posterior auricular vein were the tributaries of external jugular vein. The sound anatomical knowledge of variations of the veins of head and neck is essential to the success of surgical procedures. The embryological evaluation of the above anomaly was done and compared with the available literature which showed that the observed variation was rare.

An unusual termination of seven veins in the jugulo-subclavian junction / Inusual terminación de siete venas en la unión yugulo-subclavia

During anatomical dissection of a female Caucasian cadaver in our department, we observed an unusual termination of seven veins at the jugulo-subclavian junction. Normally, the jugulo-subclavian junction is formed by the union of the internal jugular vein and the subclavian vein, and gives rise to the brachionocephalic vein. In our case, except from these two, five additional veins, namely the cephalic vein, the transverse cervical vein, the external jugular vein, the anterior jugular vein, and the vertebral vein, were also joined at the level of the jugulo-subclavian junction, in order to form the brachionocephalic vein. Such a variation has not yet been reported in the literature.

Durante la disección anatómica de un cadáver caucásico femenino, se observó una inusual terminación de siete venas en el lugar de unión yúgulo-subclavia. Normalmente, la unión yúgulo-subclavia consiste en la unión de la vena yugular interna y la vena subclavia, que forman la vena braquiocefálica. En nuestro caso, además de estas dos venas, se observaron cinco venas adicionales, la vena cefálica, la vena cervical transversa, la vena yugular externa, la vena yugular anterior y la vena vertebral, la que también se unió en el nivel de la unión yúgulo-subclavia, a fin de formar la vena braquiocefálica. Tal variación no ha sido reportado en la literatura.

An anomalous left external jugular vein draining into right subclavian vein: a case report

Knowledge of the varying drainage patterns of superficial veins of head & neck, in particular, jugular veins are not only important for anatomists but also for the surgeons operating at this level and to clinicians in general. The variations are important for interventional radiologists too who perform transjugular procedures, such as port implantations and the transjugular intrahepatic portosystemic shunt or selective venous samplings. Results of recent studies report that the superficial veins, especially the external jugular vein (EJV), is been increasingly utilized for cannulation to conduct diagnostic and therapeutic procedures. We report a very unusual presentation of external jugular vein on left side of an embalmed male cadáver. Embryological evaluations of the anomaly was done and compared with available literature which showed that the observed variation is rare.

El conocimiento de los diferentes patrones de drenaje de las venas superficiales de la cabeza y cuello, en particular, las venas yugulares no sólo son importantes para anatomistas, sino también para los cirujanos que operan a este nivel y para los médicos en general. Las variaciones son importantes también para los radiólogos intervencionistas, quienes realizan procedimientos transyugulares, así como implantaciones portales y portosistémicas transyugulares intrahepáticas o derivación venosa selectiva. Resultados de estudios recientes informan que la venas superficiales, especialmente la vena yugular externa, es cada vez más utilizada para la canulación en diagnósticos y procedimientos terapéuticos. Se reporta una muy inusual variación anatómica de la vena yugular externa del lado izquierdo, presente en un cadáver embalsamado de sexo masculino. Fueron realizadas evaluaciones embriológicas de la anomalía y se compararon con la literatura mostrando que se trata de una variación rara.

Communication of the External and Internal Jugular Veins: A Case Report / Comunicación entre las Venas Yugulares Externa e Interna: Reporte de Caso

The external jugular vein, which traverses the sternocleidomastoid muscle superficially, is known to exhibit variations in its formation and course. There are less reports on the communication of the external and internal jugular vein. During routine cadaveric dissection, we detected an abnormal communication of the external jugular vein and the internal jugular vein, in a 45 year male cadaver. The knowledge of both normal and abnormal anatomy of the superficial veins of the neck may be important for clinicians performing catheterization and surgeons operating in the region of the neck. The presence of such anomalous communications may also be important for radiologists performing angiographic and sonographic studies.

La vena yugular externa, cruza transversal y superficialmente al músculo esternocleidomastoideo presentando variaciones en su curso y formación, existiendo algunos repórters en las comunicaciones entre ambas venas yugulares externa e interna. Durante ua disección de rutina, detectamos una anormal comunicación entre ambas venas, en una cadáver de sexo masculino de 45 años. El conocimiento de la anatomía normal y de las variaciones de las venas superficiales del cuello es importante en los procedimientos de cateterización tanto para clínicos como para cirujanos que operan en esta región. La presencia de estas variaciones de comunicación venosa es importante además, para imagenólogos y estudios sonográficos.

Ultrasound Guidance of Central Vein Catheterization by External Jugular Vein Puncture / 中华医院感染学杂志

OBJECTIVE To develop technique of central vein catheterization by external jugular vein puncture under ultrasound guidance.METHODS A total of 224 patients with central vein catheterization by external jugular vein puncture were randomized into two groups: the control group was treated by routine manipulation and observed blood vessels by macroscopic observation;the patients from the observation group were placed catheters with the assist of ultrasound techniques.To record the one time achievement ratio of catheterization and incidence of phlebitis and thrombus.RESULTS Comparing the two groups,we found the observation group had higher one time achievement ratio of catheterization and lower incidence of phlebitis and thrombus than that of the control group.And there were statistical significances between the two groups(P

Clinical analysis on reconstructing of femoral artery defects with external jugular vein graft / 中国医师进修杂志

Objective To explore the feasibility and clinical result in reconstructing of femoral artery defects with external jugular vein graft. Methods Sixteen cases of femoral artery defects caused by pseudoaneurgsm resected were reconstructed with external jugular vein graft from June 2002 to August 2005. Results The limbs of all the patients were salvaged successfully.Thirteen patients were followed up from 1 to 24 months. Their dorsal arteries of foot pulsated well, and there was no pseudoaneurgsm broken or defect recurred. Femoral nerve injury was found in one case. Femoral artery continuity was detected under the color ultrasound Doppler in 6 cases. Conclusion Reconstructing of femoral artery defects with external jugular vein graft is feasible, the effect of which is sure. The shortcoming is that the scar on the neck affects appearance after resect of external jugular vein.

External Jugular Vein: Another Landmark for Right Internal Jugular Vein Cannulation Using Ultrasound Imaging / 대한마취과학회지

BACKGROUND: Measuring the distance between internal jugular vein (IJV) and external jugular vein (EJV) on ultrasound image can give the information of the whereabouts of the IJV. We compared the success rate between carotid artery (CA)-guided and EJV-guided cannulation based on the information gathered from ultrasound. METHODS: We studied 152 patients requiring central venous cannulation during anesthesia. Ultrasound images were obtained with 7.5 MHz probe on the right neck at 0 degree, 30 degrees, and maximum rotation of the head in flat and 15 degrees Trendelenberg (T) position. The horizontal diameter of the RIJV and % overlap of the CA with the RIJV at each position, and the horizontal distance of RIJV-REJV at 30 degrees were measured on ultrasound images. In EJV group, the distance of RIJV-REJV was drawn along the cricoid level and the point of IJV was marked as the needle insertion site. Cannulation was performed with palpation of the CA in CA group and performed at the marked point in EJV group without palpation of CA. RESULTS: Overall RIJV diameter was increased in T-position compared to flat position. Following head rotation, RIJV diameter was decreased and % overlap of CA was increased (P < 0.05). In 26.8% of patients at 30 degrees in T position, CA overlapped 26-50% of RIJV. The success rate of cannulation at the first trial was 97.4% in CA group and 96.1% in REJV group. CONCLUSIONS: With the IJV identified on ultrasound image, the distance between the IJV and the EJV can be used as another landmark for RIJV cannulation provided the EJV is visualized with the naked eye.