Isolated saccular aneurysm of the external jugular vein

Venous aneurysm of the head and neck is a rare clinical entity due to its asymptomatic nature and tendency of clinicians to report only surgical results. Whereas the primary aneurysm of internal jugular vein (IJV) in children is being increasingly recognized, secondary aneurysms of veins of the head and neck in adults, notably the external jugular vein (EJV) aneurysm remains only in anecdotal case reports. We present the case of a 63-year-old previously healthy woman who presented with a gradually progressive right lateral neck swelling over the last 18 months. Following the evaluation, she was diagnosed as a case of isolated spontaneous right-sided EJV aneurysm and was managed by surgical excision of the aneurysm.

Is hepatojugular reflux a good predictor of heart failure with preserved ejection fraction?

SUMMARY Hypertension may occur with left ventricular (LV) diastolic dysfunction, and the consequence may be symptoms and signs of heart failure (HF). Hepatojugular reflux (HJR), described as a sign of regurgitation of the tricuspid valve, may reflect structural and functional changes of the LV in the hypertensive patient. The signal may be present in the presence of HF. Case: male, 49 years old with uncontrolled blood pressure. Physical examination showed jugular turgescence, HJR, and elevated blood pressure. Complementary exams showed signs of atrial and left ventricular overload in the electrocardiogram and, the echocardiogram showed left atrium volume increase, concentric LV hypertrophy and signs of grade I diastolic dysfunction. DISCUSSIO: The HJR present correlates with pulmonary artery pressure and probably reflect the increase in central blood volume.

RESUMO A hipertensão pode cursar com disfunção diastólica de ventrículo esquerdo (VE) e a consequência disso pode ser sintomas e sinais de insuficiência cárdica (IC). O refluxo hepatojugular (RHJ), descrito como sinal de regurgitação da valva tricúspide, pode refletir alterações estruturais e funcionais do VE no paciente hipertenso. O sinal pode estar presente na vigência de IC. Caso: homem, 49 anos compressão arterial não controlada. Ao exame físico apresentou turgência jugular, RHJ e pressão arterial elevada. Os exames complementares mostraram sinais de sobrecarga atrial e de ventrículo esquerdo no eletrocardiograma, e no ecocardiograma foi evidenciado aumento do volume do átrio esquerdo, hipertrofia concêntrica do VE e sinais de disfunção diastólica grau I. DISCUSSÃO: RHJ presente correlaciona-se com a pressão da artéria pulmonar e provavelmente reflete o aumento do volume sanguíneo central.

Rapamycin Combined with α-Cyanoacrylate Contributes to Inhibiting Intimal Hyperplasia in Rat Models / Rapamicina em Combinação com α-Cianoacrilato Contribui à Inibição de Hiperplasia Intimal em Modelos em Ratos

Abstract Background: Vein graft restenosis has an adverse impact on bridge vessel circulation and patient prognosis after coronary artery bypass grafting. Objectives: We used the extravascular supporter α-cyanoacrylate (α-CA), the local application rapamycin/sirolimus (RPM), and a combination of the two (α-CA-RPM) in rat models of autogenous vein graft to stimulate vein graft change. The aim of our study was to observe the effect of α-CA, RPM, and α-CA-RPM on vein hyperplasia. Methods: Fifty healthy Sprague Dawley (SD) rats were randomized into the following 5 groups: sham, control, α-CA, RPM, and α-CA-RPM. Operating procedure as subsequently described was used to build models of grafted rat jugular vein on carotid artery on one side. The level of endothelin-1 (ET-1) was determined by enzyme-linked immunosorbent assay (ELISA). Grafted veins were observed via naked eye 4 weeks later; fresh veins were observed via microscope and image-processing software in hematoxylin-eosin (HE) staining and immunohistochemistry after having been fixed and stored" (i.e. First they were fixed and stored, and second they were observed); α-Smooth Muscle Actin (αSMA) and von Willebrand factor (vWF) were measured with reverse transcription-polymerase chain reaction (RT-PCR). Comparisons were made with single-factor analysis of variance and Fisher's least significant difference test, with p < 0.05 considered significant. Results: We found that intimal thickness of the α-CA, RPM, and α-CA-RPM groups was lower than that of the control group (p < 0.01), and the thickness of the α-CA-RPM group was notably lower than that of the α-CA and RPM groups (p < 0.05). Conclusion: RPM combined with α-CA contributes to inhibiting intimal hyperplasia in rat models and is more effective for vascular patency than individual use of either α-CA or RPM.

Resumo Fundamento: Reestenose de enxertos venosos tem um impacto adverso na circulação de pontagens e no prognóstico de pacientes após a cirurgia de revascularização miocárdica. Objetivos: Nós utilizamos α-cianoacrilato (α-CA) como suporte extravascular, rapamicina/sirolimus (RPM) como aplicação local e a combinação dos dois (α-CA-RPM) em modelos de enxerto venoso autógeno em ratos para estimular mudança no enxerto venoso. O objetivo do nosso estudo foi observar o efeito de α-CA, RPM e α-CA-RPM na hiperplasia venosa. Métodos: Cinquenta ratos Sprague Dawley (SD) saudáveis foram randomizados nos 5 grupos seguintes: sham, controle, α-CA, RPM e α-CA-RPM. O procedimento operacional descrito subsequentemente foi utilizado para construir modelos de enxertos da veia jugular na artéria carótida em ratos, em um lado. O nível de endotelina-1 (ET-1) foi determinado por ensaio de imunoabsorção enzimática (ELISA). As veias enxertadas foram observadas a olho nu 4 semanas após; as veias frescas foram observadas via microscópio e software de processamento de imagem com coloração hematoxilina-eosina (HE) e imuno-histoquímica depois de serem fixadas e armazenadas; α-actina do músculo liso (αSMA) e o fator de von Willebrand (vWF) foram medidos com reação em cadeia da polimerase-transcriptase reversa (RT-PCR). Realizaram-se as comparações com análise de variância de fator único (ANOVA) e o teste de diferença mínima significativa (LSD) de Fisher, com p < 0,05 sendo considerado estatisticamente significante. Resultados: Nós achamos que a espessura intimal nos grupos α-CA, RPM e α-CA-RPM era menor que no grupo controle (p < 0,01) e a espessura no grupo α-CA-RPM era notavelmente menor que nos grupos α-CA e RPM (p < 0,05). Conclusão: A combinação de RPM e α-CA contribui à inibição de hiperplasia em modelos em ratos e é mais efetivo para patência vascular que uso individual de α-CA ou RPM.

Tromboembolismo pulmonar séptico secundário à síndrome de Lemierre / Septic pulmonary thromboembolism due to Lemierre syndrome

Descrita pela primeira vez em 1900 por Coumont e Cade, a tromboflebite séptica da veia jugular interna (síndrome de Lemierre) é uma condição rara. Acomete indivíduos jovens e possui elevada morbimortalidade. Relatamos o caso de uma paciente atendida inicialmente como portadora de amigdalite bacteriana e que retornou com piora do quadro, associado à trombose da veia jugular interna, evoluindo, na internação, com embolia séptica pulmonar. Além de relatar o caso, fazemos breve revisão da literatura e chamamos a atenção sobre este importante assunto.(AU)

First described in 1900 by Coumont and Cade, septic thrombophlebitis of the internal jugular vein (Lemierre's syndrome) is relatively rare. It affects young patients and has high morbidity and mortality. We describe the case of a woman first diagnosed with a bacterial tonsillitis, who returned to the hospital with worsening of the condition, associated with internal jugular vein thrombophlebitis, that developed to pulmonary embolism during her hospitalization. We reported the case, and made a brief review of the literature, highlighting the details of this important condition.(AU)

Experimental study of histological changes in vascular loops according to the duration of the postoperative period: Application in reconstructive microsurgery

OBJECTIVES: To analyze the histological changes observed in venous grafts subjected to arterial blood flow as a function of the duration of the postoperative period to optimize their use in free flap reconstructions. METHOD: Twenty-five rats (7 females and 18 males) underwent surgery. Surgeries were performed on one animal per week. Five weeks after the first surgery, the same five animals were subjected to an additional surgery to assess the presence or absence of blood flow through the vascular loop, and samples were collected for histological analysis. This cycle was performed five times. RESULTS: Of the rats euthanized four to five weeks after the first surgery, no blood flow was observed through the graft in 80% of the cases. In the group euthanized three weeks after the first surgery, no blood flow was observed in 20% of the cases. In the groups euthanized one to two weeks after the first surgery, blood flow through the vascular loop was observed in all animals. Moreover, intimal proliferation tended to increase with the duration of the postoperative period. Two weeks after surgery, intimal proliferation increased slightly, whereas strong intimal proliferation was observed in all rats evaluated five weeks after surgery. CONCLUSION: Intimal proliferation was the most significant change noted in venous grafts as a function of the duration of the postoperative period and was directly correlated with graft occlusion. In cases in which vascular loops are required during free flap reconstruction, both procedures should preferably be performed during the same surgery.

Central Venous Stenosis Caused by Traction of the Innominate Vein due to a Tuberculosis-Destroyed Lung

We report a case of central venous stenosis due to a structural deformity caused by a tuberculosis-destroyed lung in a 65-year-old woman. The patient presented with left facial edema. She had a history of pulmonary tuberculosis, and the chest X-ray revealed a collapsed left lung. Angiography showed leftward deviation of the innominate vein leading to kinking and stenosis of the internal jugular vein. Stent insertion improved her facial edema.

Afecções vasculares do osso temporal: diagnóstico diferencial e tratamento / Vascular affection of temporal bone: differential diagnostic and therapeutic approach

Introdução: As afecções vasculares do osso temporal cursam com história clínica e exame físico semelhantes e podem ser diferenciados através de exames de imagem, os mais comuns são: paragangliomas, bulbo de jugular alto e artéria carótida aberrante. Os paragangliomas são tumores bem vascularizados formados por capilares e pré-capilares interpostos por células de origem neuroectodérmica. O bulbo jugular é a região anatômica correspondente à união do seio sigmóide e da veia jugular interna e é denominado bulbo de jugular alto quando há protusão da veia jugular interna para o interior da cavidade timpânica. A artéria carótida interna normalmente penetra no osso petroso pelo canal carotídeo separada da veia jugular interna pela bainha carotídea, no segmento vertical inicial está separada da orelha média por uma placa óssea. O trajeto anormal da artéria carótida interna pode ser explicado por malformação embrionária que impede a formação da placa óssea. Objetivo: O objetivo deste estudo é relatar cinco casos de afecções vasculares do osso temporal e discutir o diagnóstico diferencial e tratamento destas lesões.

Introduction: The vascular affections of temporal bone follow similar clinical symptoms and signs and can be distinguished through radiological investigation. The usual ones are: paraganglioma, high jugular bulb and aberrant internal carotid artery. The paraganglioma are vascular tumor formed by capillaries and pre-capillaries vessels originating from neuroectodermical cells. The jugular bulb is the anatomic point which joins sigmoid sinus and jugular vein; it is called high jugular bulb when the jugular vein protrudes into tympanic cavity. The carotid artery enters the etrous bone through the carotid canal that is apart from jugular vein by carotid sheath, in initial vertical segment it is apart from the middle ear by a bone plate. The abnormal course of the carotid artery can be explained by an embryological malformation that prevents bone plate formation. Objective: The target of this study is to report five cases of vascular affections of temporal bone and to discuss their differential diagnostic and therapeutic approach.

Congenital phlebectasia of the internal jugular vein [case report]

Congenital phlebectasia of the jugular vein is a rare entity and there are few reports from the world about this subject. Here we present a child with congenital phlebectasia of the right internal jugular vein, which appeared as a compressible mass in the neck during straining and coughing. It is important to differentiate it from other neck masses. Colored Doppler is a simple non invasive procedure for diagnosis. The treatment is conservative for asymptomatic patients

Unilateral internal jugular phlebectasia.

Jugular phlebectasia is a rare cause of cervical swelling in children. It is a fusiform dilatation of any part of the jugular venous system and can involve the external, internal or anterior jugular veins. Previous reports suggest that the entity is often ignored or misdiagnosed. Unilateral internal jugular phlebactasia presenting as an intermittent neck swelling in a ten-year-old girl is reported. The clinical features are analyzed and the appropriate use of noninvasive imaging modalities is highlighted. The literature is also briefly reviewed.

Tentorial meningioma encroaching the transverse sinuses and sigmoid sinus junction area associated with dural arteriovenous fistulous malformation: a case report

A 62-year-old woman was evaluated for tinnitis and headache. Magnetic resonance imaging and angiography revealed the coexistence of a tentorial tumor encroaching the junction of the right transverse-sigmoid sinuses, and dural arteriovenous fistulous malformation (AVFM) of the right transverse sinus. AVFM was not manipulated at all during the surgery. The pathology was fibroblastic meningioma. Postoperatively, the dural AVFM completely disappeared on follow-up angiography. The fistulas were occluded also after surgery, even though there was no manipulation of the AVFM. It is suggested that the right dominant transverse-sigmoid sinuses are partially occluded by tentorial meningioma, developing the dural arteriovenous fistula of the right transverse sinus. An acquired origin of the dural AVFM was suggested in this case.

Phlebectasie jugulaire ou ectasie veineuse jugulaire chez l'enfant

Jugular phlebectasia is a congenital dilatation in the way of jugular vein or one of its original branches. It presents generally as a depressible mass, and become replete on moments of cry or on valsavas maneuver. it may be discerned of other latero-cervical tumors as the laryngocele and lymphangioma. Echography and Doppler are perfomed for the diagnosis. Treatment consists at the excision of the ectasie segment and so avoid complications of a benign pathology

Flebectasias del sistema venoso yugular, a propósito de un caso / Phlebectasia of the anterior jugular vein: 1 case report

Se presenta un caso de flebectasia de la vena yugular anterior, en una adolescente de once años de edad vista por presentar tumoración laterocervical izquierda que se hacia aparente con esfuerzo como toser, estornudar o de ejercicios físicos. Se exponen los medios diagnósticos empleados y se reseñan los tratamientos y hallazgos histopatológicos reportados por distintos autores

Trombosis venosa del sistema yúgulosubclavio inducida por catéteres: su estudio con ecografía Doppler duplex pulsado / Doppler US deep venous thrombosis of the jugular and subclavian veins induced by catheters

En los últimos años el adelanto experimentado en el manejo y tratamiento de pacientes en situación crítica y condición grave, internados en salas de Terapia Intensiva o de Cuidados Críticos, llevaron a la necesidad de utilizar catéteres centrales, canalizaciones, etc. para efectuar el tratamiento por vía endovenosa adecuado. Todos ellos utilizan habitualmente como vía de acceso a la vena subclavia y en otras oportunidades la yugular. La cateterización de dichas venas llevan a la trombosis en el 28% de los casos y al tromboembolia pulmonar (TEP) en el 12%. Se presentan 9 casos de trombosis venosa profunda (TVP) del sistema yúgulosubclavio inducida por la colocación de catéteres: 6 casos de TVP de la vena subclavia y 3 casos de la vena yugular. Se describen los signos ecográficos característicos de TVP y en especial se remarca el signo de la "ausencia del batido de la válvula venosa" y el cut off sing (pérdida de los límites de la vasculatura normal con pobre definición del trombo) descriptos por Wiessleder para trombosis de la vena yugular interna