BACKGROUND Atrial fibrillation(AF)is the most common cardiac arrhythmia worldwide,hosting numerous serious possible complications such as stroke and heart failure.In the past two decades,managing rhythm control was mo...BACKGROUND Atrial fibrillation(AF)is the most common cardiac arrhythmia worldwide,hosting numerous serious possible complications such as stroke and heart failure.In the past two decades,managing rhythm control was more successful via pulmonary vein isolation(PVI)ablation,generally performed via transfemoral access.Patients with anatomical variations may necessitate a dose of creativity and evidence-based techniques.To our knowledge,we present the first PVI case in a patient with AF via right internal jugular(IJ)vein access using pulse field ablation.CASE SUMMARY A 76-year-old male with an extensive medical history notable for type 2 diabetes and severe peripheral vascular disease requiring vascular bypass surgery is identified to have paroxysmal AF.Given functional decline and worsening arrhythmia burden refractory to oral antiarrhythmics,an initial PVI ablation was attempted but failed as the catheter could not be advanced secondary to bilateral iliac vein occlusions.This necessitated a novel approach and a subsequent PVI ablation via the right IJ vein was successful without any complications.The success of this case highlights the feasibility of an IJ approach for PVI in patients where traditional access is not possible.This case can be used as a reference for other practitioners who may face similar challenges when attempting to perform PVI for AF or similar procedures requiring access to similar anatomical locations.CONCLUSION The success of this case highlights the feasibility of an IJ approach for PVI when traditional access is impossible.展开更多
Point-of-care ultrasound(POCUS)of the internal jugular vein(IJV)offers a noninvasive means of estimating right atrial pressure(RAP),especially in cases where the inferior vena cava is inaccessible or unreliable due to...Point-of-care ultrasound(POCUS)of the internal jugular vein(IJV)offers a noninvasive means of estimating right atrial pressure(RAP),especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery.While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein,this method lacks sensitivity.The utilization of POCUS significantly enhances the visualization of the vein,leading to a more accurate identification.It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation.This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein,drawing upon existing data.展开更多
Central venous catheterization(CVC)is an invasive medical procedure used to measure central venous pressure and provides a stable route for continuous drug administration.CVC is widely used in the emergency department...Central venous catheterization(CVC)is an invasive medical procedure used to measure central venous pressure and provides a stable route for continuous drug administration.CVC is widely used in the emergency department and intensive care units.It is typically performed by inserting a catheter through the internal jugular vein(IJV)into the superior vena cava near the right atrium.[1,2]While catheterization is a fundamental skill proficiently performed by healthcare professionals,lethal complications may occasionally occur because of undesirable positioning,depth and diameter.展开更多
This paper models the giraffe’s jugular veins as a uniform collapsible tube from a rigid skull. The equations governing one-dimensional steady flow through such a tube for various conditions have been developed. The ...This paper models the giraffe’s jugular veins as a uniform collapsible tube from a rigid skull. The equations governing one-dimensional steady flow through such a tube for various conditions have been developed. The effects of inertial and inclination angles that have not been discussed previously have been included. It has been shown that different flows for a uniform tube (vein) are possible. However, this flow matches that of a jugular vein which is supercritical, and the steady solution has been given by the balance between the driving forces of gravity and the viscous resistance to the flow at the right atrium of the heart must be sub-critical for a fixed right-atrium pressure which means that an elastic jump is required to return the flow to sub-critical from the supercritical flow upstream this type of relationship gives rise to flow limitation at the same time given any right atrium fixed pressure there exists a maximum flow rate which when exceeded the boundary conditions of the flow do not hold boundary conditions at the right atrium are not satisfied hence making the steady flow impossible this mechanism of flow limitation is slightly different from the other one in that causes airways through forced expiration from the observation made it is clearly shown that there is an intravascular pressure difference with a change in height.展开更多
Objective: To clarify the role of the “Three Threes” method in clinical teaching of internal jugular vein puncture and explore improvements in teaching methods. Methods: A doctor was assigned to the induction room o...Objective: To clarify the role of the “Three Threes” method in clinical teaching of internal jugular vein puncture and explore improvements in teaching methods. Methods: A doctor was assigned to the induction room of the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) for two months. The time required for catheterization, the first puncture success rate, and occurrence of puncture-related complications were compared before and after learning the “Three Threes” method. Results: Using the “Three Threes” method reduced the catheterization time by 43%, increased the first puncture success rate by 17%, and led to fewer puncture-related complications. Conclusion: The application of the “Three Threes” method not only improves the success rate of internal jugular vein puncture but also reduces complications, making it easier for students to master the technique.展开更多
Context and Justification: The sigmoido-jugular junction connects two structures of different compositions and has a complex organization. The sinusoidal portion of its endothelium contains muscle cells in adults. Is ...Context and Justification: The sigmoido-jugular junction connects two structures of different compositions and has a complex organization. The sinusoidal portion of its endothelium contains muscle cells in adults. Is this the same presentation observed in fetuses? Objective: To describe the sigmoido-jugular junction in fetuses. Materials and Methods: Over a period of seven months, a histochemical and immunohistochemical study was conducted on 30 sigmoido-jugular junctions taken from 15 fetuses aged at least 32 weeks of gestation. These fetuses were obtained following expulsion due to intrauterine death, after informed consent from the parents. Results: Three portions can be identified: sigmoid, junctional, and jugular. Histochemical preparations revealed the existence of two constant layers and a third layer present only at the jugular level. From the inside out, the layers are as follows: 1) Inner Layer (Endothelium): This layer is clearer from the junction and reveals the presence of smooth muscle cells at the sigmoid level in immunohistochemistry. 2) Outer Layer: At the sigmoid and junctional levels, this layer consists of collagen fibers and becomes median at the jugular level, where it is composed of elastic and muscular collagen fibers. 3) Third Layer: Present only at the jugular level, this layer corresponds to the adventitia. Conclusion: The architecture of the sigmoido-jugular junction in fetuses, which is identical to that in adults, excludes the metaplastic hypothesis regarding endothelial smooth muscle cells in the sigmoid portion. Instead, it favors their role in regulating encephalic venous drainage.展开更多
<strong>Objectives:</strong> Pulsatile tinnitus involves a wide spectrum of etiologies. The etiologies include normal vascular variants, temporal bone tumor, acquired vascular lesions and chronic middle ea...<strong>Objectives:</strong> Pulsatile tinnitus involves a wide spectrum of etiologies. The etiologies include normal vascular variants, temporal bone tumor, acquired vascular lesions and chronic middle ear inflammatory diseases. Jugular bulb diverticulum is a rare cause of pulsatile tinnitus. We report one case of jugular diverticulum presenting with pulsatile tinnitus and its surgical management and outcome. <strong>Case Report:</strong> A 36-year-old woman with a history of uterine myoma and chronic anemia presented with right pulsatile tinnitus that was worsening in recent one month. Neurological exam was normal. ENT evaluation revealed no abnormalities via otoscopy and physical examination. The CT scan revealed right dominant jugular bulb with diverticulum projecting to posterior ear canal wall. We performed jugular bulb diverticulum resurfacing with temporalis fascia, Surgicel<sup>®</sup> and Gelfoam<sup>®</sup>, and bone wax via transmastoid approach. The symptom improved postoperative immediately. No major complications were noted during outpatient clinic follow-up. <strong>Conclusion:</strong> Transmastoid resurfacing of jugular bulb diverticulum is an effective management of pulsatile tinnitus from this kind vascular anomaly.展开更多
Lemierre’s syndrome(LS)is an uncommon condition with oropharyngeal infections,internal jugular vein thrombosis,and systemic metastatic septic embolization as the main features.Fusobacterium species,a group of strictl...Lemierre’s syndrome(LS)is an uncommon condition with oropharyngeal infections,internal jugular vein thrombosis,and systemic metastatic septic embolization as the main features.Fusobacterium species,a group of strictly anaerobic Gram negative rod shaped bacteria,are advocated to be the main pathogen involved.We report a case of LS complicated by pulmonary embolism and pulmonary septic emboli that mimicked a neoplastic lung condition.A Medline search revealed 173 case reports of LS associated with internal jugular vein thrombosis that documented the type of microorganism.Data confirmed high prevalence in young males with Gram negative infections(83.2%).Pulmonary embolism was reported in 8.7% of cases mainly described in subjects with Gram positive infections(OR=9.786;95%CI:2.577-37.168,P=0.001),independently of age and gender.Only four fatal cases were reported.LS is an uncommon condition that could be complicated by pulmonary embolism,especially in subjects with Gram positive infections.展开更多
Objective： The subclavian vein （SCV） is usually used to inject the indicator of cold saline for a transpul- monary thermodilution （TPTD） measurement. The SCV catheter being misplaced into the internal jugular （...Objective： The subclavian vein （SCV） is usually used to inject the indicator of cold saline for a transpul- monary thermodilution （TPTD） measurement. The SCV catheter being misplaced into the internal jugular （IJV） vein is a common occurrence. The present study explores the influence of a misplaced SCV catheter on TPTD variables. Methods： Thirteen severe acute pancreatitis （SAP） patients with malposition of the SCV catheter were enrolled in this study. TPTD variables including cardiac index （CI）, global end-diastolic volume index （GEDVI）, intrathoracic blood volume index （ITBVI）, and extravascular lung water index （EVLWl） were obtained after injection of cold saline via the misplaced SCV catheter. Then, the misplaced SCV catheter was removed and IJV access was constructed for a further set of TPTD variables. Comparisons were made between the TPTD results measured through the IJV and mis- placed SCV accesses. Results： A total of 104 measurements were made from TPTD curves after injection of cold saline via the IJV and misplaced SCV accesses. Bland-Altman analysis demonstrated an overestimation of ＋111.40 ml/m2 （limits of agreement： 6.13 and 216.70 ml/m2） for GEDVI and ITBVI after a misplaced SCV injection. There were no significant influences on CI and EVLWI. The biases of ＋0.17 L/（min.m2） for CI and ＋0.17 ml/kg for EVLWI were re- vealed by Bland-Altman analysis. Conclusions： The malposition of an SCV catheter does influence the accuracy of TPTD variables, especially GEDVI and ITBVI. The position of the SCV catheter should be confirmed by chest X-ray in order to make good use of the TPTD measurements.展开更多
Background: The aim of this study was to evaluate the safety and feasibility of venous access via the internal jugular vein (IJV) for totally implantable venous access device (TIVAD) placements. In Japan, TIVADs are g...Background: The aim of this study was to evaluate the safety and feasibility of venous access via the internal jugular vein (IJV) for totally implantable venous access device (TIVAD) placements. In Japan, TIVADs are generally placed in position by the percutaneous subclavian vein puncture approach (SVPA). However, this approach causes infrequent intraoperative or postoperative complications. Using the internal jugular vein puncture approach (IJVPA), TIVADs could be placed more easily and safely. Materials and Methods: Fifty-six patients who received TIVADs for chemotherapy of colorectal carcinomas were enrolled in this study. The choice of approach (IJVPA or SVPA) was adopted at the discretion of each doctor in charge of the patient. The operation time, success rate and complications of the two approaches were compared and evaluated. Results: TIVAD placement was successful in all patients. Thirty patients received the device via IJV puncture, but 1 patient required conversion to SVPA. Twenty-six patients underwent SVPA for device placement, but 3 of these patients required conversion to IJVPA. Mean operation time was 34.3 min in IJVPA and 35.2 min in SVPA. The success rate was 96.6% in IJVPA and 88.5% in SVPA. No severe perioperative complications were observed. However, long-term complications were observed in five cases, 3 by IJVPA and 2 by SVPA, but no significant difference in the rate of complications was observed between these two approaches. A catheter-related thrombosis was found by CT scan in 3 patients, two of whom underwent IJVPA (6.7%) and one case underwent SVPA (3.8%). Two patients received simultaneous administration of bevacizumab. Catheter infections occurred in 1 patient who underwent IJVPA (3.3%) and 1 patient who underwent SVPA (3.8%). Conclusions: The IJVPA is a safe and feasible method for TIVAD placement.展开更多
Neurofibromatosis type 1 is a congenital condition affecting neurons and connective tissue integrity including vasculature.On extremely rare occasions these patients present with venous aneurysms affecting the interna...Neurofibromatosis type 1 is a congenital condition affecting neurons and connective tissue integrity including vasculature.On extremely rare occasions these patients present with venous aneurysms affecting the internal jugular vein.If they become large enough there presents a risk of rupture,thrombosis,embolization or compression of adjacent structures.In these circumstances,or when the patient becomes symptomatic,surgical exploration is warranted.We present a case of one of the largest aneurysms in the literature and one of only five associated with Neurofibromatosis type 1.A 63-year-old female who initially presented for a HincheyⅢdiverticulitis requiring laparotomy developed an incidentally discovered left neck swelling prior to discharge.After nonspecific clinical exam findings,imaging identified a thrombosed internal jugular vein aneurysm.Due to the risks associated with the particularly large size of our patient's aneurysm,our patient underwent surgical exploration with ligation and excision.Although several techniques have been reported,for similar presentations,we recommend this technique.展开更多
BACKGROUND Grade II and III meningiomas[World Health Organization(WHO)classification]rarely have extracranial metastases via the blood circulation;however,we experienced a case with a metaplastic atypical meningioma a...BACKGROUND Grade II and III meningiomas[World Health Organization(WHO)classification]rarely have extracranial metastases via the blood circulation;however,we experienced a case with a metaplastic atypical meningioma and local dedifferentiation that metastasized to the jugular vein,carotid artery and subclavian artery at the cervicothoracic junction.Such cases have seldom been reported before.CASE SUMMARY The patient was a 30-year-old man who developed right neck masses with dysphagia,labored breathing,dizziness,and occasional earaches.Eight months earlier the patient was diagnosed with a right parietal lobe neoplasm and hemorrhage at a local hospital due to the sudden onset of headaches and left limb weakness,and the post-operative pathology was a metaplastic atypical meningioma(WHO grade II)with local de-differentiation(WHO III).Magnetic resonance imaging revealed a calcified mass at the root of the neck on the right and a large cystic mass in the right parapharyngeal space.Head and neck angiography showed that the right common carotid artery was compressed and completely occluded,and the jugular vein was enveloped by the tumor and occluded.A balloon occlusion test showed no perfusion in the right common carotid artery.Tumor resection,carotid artery ligation,and subclavian artery reconstruction were performed.The tumor was a malignant meningioma.Postoperatively,the patient had Horner's syndrome and hoarseness.CONCLUSION This case highlights the importance of the link between a large cervical mass and a primary intracranial tumor.Malignant meningioma should not be considered merely as an intracranial metastasis spread through cerebrospinal fluid,it can also be transferred through the circulation to the parapharyngeal space and the cervical great vessels.展开更多
Observation: This patient was a 40-year-old housewife with dysphonia, physical asthenia, palpitations, fever and cervical tumefaction that had been going on for 2 months, no known cardiovascular risk factor, such as m...Observation: This patient was a 40-year-old housewife with dysphonia, physical asthenia, palpitations, fever and cervical tumefaction that had been going on for 2 months, no known cardiovascular risk factor, such as medical history, ischemic stroke. Heart sounds were regular at 110 bpm, blood pressure = 120/80 mmhg, to the lungs there are sibilant rattles. Elsewhere, there is a painful left lateral cervical tumefaction febrile to the touch. Temperature = 38°C. The rest of the exam is peculiar. Conclusion: Jugular vein thrombosis is a rare variety of unusual localization of venous thromboembolism. It must be suspected in the presence of a painful cervical swelling and confirmed by magnetic resonance imaging or to scan with contrast or ultrasound. Anticoagulant therapy should be instituted as soon as possible to avoid the formidable complication of pulmonary embolism.展开更多
BACKGROUND Central venous catheter insertion is an invasive procedure that can cause complications such as infection,embolization due to air or blood clots,pneumothorax,hemothorax,and,rarely,chylothorax due to damage ...BACKGROUND Central venous catheter insertion is an invasive procedure that can cause complications such as infection,embolization due to air or blood clots,pneumothorax,hemothorax,and,rarely,chylothorax due to damage to the thoracic duct.Herein,we report a case of suspected thoracic duct cannulation that occurred during left central venous catheter insertion.Fortunately,the patient was discharged without any adverse events related to thoracic duct cannulation.CASE SUMMARY A 46-year-old female patient presented at our department to undergo cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.During anesthesia,we decided to insert a central venous catheter through the left internal jugular vein because the patient already had a chemoport through the right central vein.During the procedure,blood reflux was observed when the needle tip was not within the ultrasound field of view.We did not try to find the tip;however,a guide wire and a central venous catheter were inserted without any resistance.Subsequently,when inducing blood reflux from the distal port of the central venous catheter,only clear fluid,suspected to be lymphatic fluid,was regurgitated.Further,chest X-ray revealed an appearance similar to that of the path of the thoracic duct.Given that intravenous fluid administration was not started and no abnormal fluid collection was noted on preoperative chest X-ray,we suspected thoracic duct cannulation.CONCLUSION It is important to use ultrasound to confirm the exact position of the needle tip and guide wire path.展开更多
Inflammation of a part or whole of the temporal bone and surrounding soft tissue is termed as malignant otitis externa,which typically spreads to skull base to involve cranial nerves VII.Rarely can it also effect one ...Inflammation of a part or whole of the temporal bone and surrounding soft tissue is termed as malignant otitis externa,which typically spreads to skull base to involve cranial nerves VII.Rarely can it also effect one or more of cranial nerves IX,X,XI,and XII.We present a case of malignant otitis externa which presented with symptomatic palsy of IX and XII nerves sparing the VII cranial nerve.The patient though later on had internal jugular vein thrombosis,which we presume is due to the involvement of the parapharyngeal space that prompted us to reconsider the diagnosis,and later on,to aggravate the therapy.With proper blood sugar control and appropriate long term antibiotics,not only that the patient is disease free at one year follow up,but the cranial nerve deficits also recovered.Apart from sharing the clinical and management details of this patient,we have reviewed the relevant literature in the discussion,which has shed some light onto some of the interesting facts about this condition and its prognosis.展开更多
Liposomes effectively transport fatty proteins to targeted tissues. Laboratory experiments use multiple methods to administer liposomes, but comparison of these methods is not available. In this retrospective study, w...Liposomes effectively transport fatty proteins to targeted tissues. Laboratory experiments use multiple methods to administer liposomes, but comparison of these methods is not available. In this retrospective study, we characterized and compared four intravenous administration routes (tail vein, jugular catheter, femoral vein and percutaneous retro-orbital injections) in murine models. ApoE<sup>-/-</sup> mice were used to compare administration routes. Results indicate that the jugular catheter route delivered the highest amount of liposomes to tissues due to longer period of injections compared to other routes;however, this route failed to remain patent for 8/10 animals. Delivery via tail vein, femoral vein and percutaneous retro-orbital injections resulted in similar accumulation in the organs. When including technical difficulty and expense, percutaneous retro-orbital injections of liposomes are the most convenient and efficacious approach.展开更多
BACKGROUND Hemothorax is a rare but life-threatening complication of central venous catheterization.Recent reports suggest that ultrasound guidance may reduce complications however,it does not guarantee safety CASE SU...BACKGROUND Hemothorax is a rare but life-threatening complication of central venous catheterization.Recent reports suggest that ultrasound guidance may reduce complications however,it does not guarantee safety CASE SUMMARY A 75-year-old male patient was admitted for laparoscopic radical nephrectomy.Under ultrasound guidance,right internal jugular vein catheterization was successfully achieved after failure to aspirate blood from the catheter in the first attempt.Sudden hypotension developed after surgical positioning and persisted until the end of the operation,lasting for about 4 h.In the recovery room,a massive hemothorax was identified on chest radiography and computed tomography.The patient recovered following chest tube drainage of 1.6 L blood.CONCLUSION Hemothorax must be suspected when unexplained hemodynamic instability develops after central venous catheterization despite ultrasound guidance.So the proper use of ultrasound is important.展开更多
Rationale:Thrombosis of the internal jugular vein is an infrequent and underdiagnosed pathology due to the absence of symptoms.If present,the symptoms are frequently manifested as a sensation of pain and cervical tens...Rationale:Thrombosis of the internal jugular vein is an infrequent and underdiagnosed pathology due to the absence of symptoms.If present,the symptoms are frequently manifested as a sensation of pain and cervical tension.Its etiology is variable,including trauma,central catheterization,and hypercoagulable states,among others.Patient’s Concern:A 41-year-old female,previously healthy,was admitted to the emergency room for worsening pain in the left cervical area of 5 d.Previously,she was treated for suspected acute pharyngotonsillitis yet without improvement.Diagnosis:Physical examination revealed a 2 cm in length cervical mass of hard consistency that was painful on palpation and non-fluctuating.Ultrasound study showed thrombosis of the left internal jugular vein.A computed tomography scan revealed that the thrombosis occurred at the cervical portion of the left internal jugular vein as well as the left transverse sinus.Interventions:Hospital admission and treatment with low molecular weight heparin at a dose of 1.5 mg/kg every 24 h.Outcomes:The patient was discharged after 3 d of treatment with vitamin K antagonists.Lessons:Venous thrombosis at the level of the internal jugular vein is an infrequent entity.Clinical suspicion is necessary for the diagnosis given the possibility of absence of symptoms.展开更多
Background/Purpose: The right internal jugular vein (RIJV) is the most commonly accessed central venous site in the cardiac operating room. The Trendelenburg position is frequently used to increase the cross-sectional...Background/Purpose: The right internal jugular vein (RIJV) is the most commonly accessed central venous site in the cardiac operating room. The Trendelenburg position is frequently used to increase the cross-sectional area (CSA) of the RIJV to facilitate its cannulation. However, the extent of change of RIJV CSA in response to Trendelenburg positioning in anesthetized patients and its predictive factors remain unknown. Methods: Thirty-seven patients presented for the cardiac surgery, and 20 ASA I and II surgical patients without a history of cardiac disease (control) were studied. After induction of anesthesia, RIJV CSA was measured both at supine level position and in 10-degree Trendelenburg using vascular ultrasonography. Central venous pressure was measured in cardiac surgery patients only, since the patients in control group did not require invasive lines placement. Results and Conclusions: Body-surface area, central venous pressure, type of surgery and ejection fraction did not show any correlation with the degree of RIJV CSA change. RIJV dilation in response to Trendelenburg was significantly less pronounced, and more variable, in female patients.展开更多
Internal jugular vein (IJV) ectasia is a rare benign disease. It commonly presents as a unilateral, soft, compressible neck swelling that mostly involves the right side. It is usually a childhood disease and believed ...Internal jugular vein (IJV) ectasia is a rare benign disease. It commonly presents as a unilateral, soft, compressible neck swelling that mostly involves the right side. It is usually a childhood disease and believed to be of congenital origin. Accurate diagnosis from careful history, physical examination and radiological study can be made. We report here two cases of IJV ectasia in African adults with right lateral neck mass dilating when increase intrathoracic pressure. Because of its rarity, this entity is frequently ignored or misdiagnosed. This case report intends to stress the importance of keeping IJV ectasia as differential diagnosis in mind in case of lateral neck swellings to avoid invasive investigations and inappropriate treatment. The asymptomatic case management of IJV ectasia is conservative with long-term surveillance.展开更多
文摘BACKGROUND Atrial fibrillation(AF)is the most common cardiac arrhythmia worldwide,hosting numerous serious possible complications such as stroke and heart failure.In the past two decades,managing rhythm control was more successful via pulmonary vein isolation(PVI)ablation,generally performed via transfemoral access.Patients with anatomical variations may necessitate a dose of creativity and evidence-based techniques.To our knowledge,we present the first PVI case in a patient with AF via right internal jugular(IJ)vein access using pulse field ablation.CASE SUMMARY A 76-year-old male with an extensive medical history notable for type 2 diabetes and severe peripheral vascular disease requiring vascular bypass surgery is identified to have paroxysmal AF.Given functional decline and worsening arrhythmia burden refractory to oral antiarrhythmics,an initial PVI ablation was attempted but failed as the catheter could not be advanced secondary to bilateral iliac vein occlusions.This necessitated a novel approach and a subsequent PVI ablation via the right IJ vein was successful without any complications.The success of this case highlights the feasibility of an IJ approach for PVI in patients where traditional access is not possible.This case can be used as a reference for other practitioners who may face similar challenges when attempting to perform PVI for AF or similar procedures requiring access to similar anatomical locations.CONCLUSION The success of this case highlights the feasibility of an IJ approach for PVI when traditional access is impossible.
文摘Point-of-care ultrasound(POCUS)of the internal jugular vein(IJV)offers a noninvasive means of estimating right atrial pressure(RAP),especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery.While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein,this method lacks sensitivity.The utilization of POCUS significantly enhances the visualization of the vein,leading to a more accurate identification.It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation.This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein,drawing upon existing data.
文摘Central venous catheterization(CVC)is an invasive medical procedure used to measure central venous pressure and provides a stable route for continuous drug administration.CVC is widely used in the emergency department and intensive care units.It is typically performed by inserting a catheter through the internal jugular vein(IJV)into the superior vena cava near the right atrium.[1,2]While catheterization is a fundamental skill proficiently performed by healthcare professionals,lethal complications may occasionally occur because of undesirable positioning,depth and diameter.
文摘This paper models the giraffe’s jugular veins as a uniform collapsible tube from a rigid skull. The equations governing one-dimensional steady flow through such a tube for various conditions have been developed. The effects of inertial and inclination angles that have not been discussed previously have been included. It has been shown that different flows for a uniform tube (vein) are possible. However, this flow matches that of a jugular vein which is supercritical, and the steady solution has been given by the balance between the driving forces of gravity and the viscous resistance to the flow at the right atrium of the heart must be sub-critical for a fixed right-atrium pressure which means that an elastic jump is required to return the flow to sub-critical from the supercritical flow upstream this type of relationship gives rise to flow limitation at the same time given any right atrium fixed pressure there exists a maximum flow rate which when exceeded the boundary conditions of the flow do not hold boundary conditions at the right atrium are not satisfied hence making the steady flow impossible this mechanism of flow limitation is slightly different from the other one in that causes airways through forced expiration from the observation made it is clearly shown that there is an intravascular pressure difference with a change in height.
文摘Objective: To clarify the role of the “Three Threes” method in clinical teaching of internal jugular vein puncture and explore improvements in teaching methods. Methods: A doctor was assigned to the induction room of the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) for two months. The time required for catheterization, the first puncture success rate, and occurrence of puncture-related complications were compared before and after learning the “Three Threes” method. Results: Using the “Three Threes” method reduced the catheterization time by 43%, increased the first puncture success rate by 17%, and led to fewer puncture-related complications. Conclusion: The application of the “Three Threes” method not only improves the success rate of internal jugular vein puncture but also reduces complications, making it easier for students to master the technique.
文摘Context and Justification: The sigmoido-jugular junction connects two structures of different compositions and has a complex organization. The sinusoidal portion of its endothelium contains muscle cells in adults. Is this the same presentation observed in fetuses? Objective: To describe the sigmoido-jugular junction in fetuses. Materials and Methods: Over a period of seven months, a histochemical and immunohistochemical study was conducted on 30 sigmoido-jugular junctions taken from 15 fetuses aged at least 32 weeks of gestation. These fetuses were obtained following expulsion due to intrauterine death, after informed consent from the parents. Results: Three portions can be identified: sigmoid, junctional, and jugular. Histochemical preparations revealed the existence of two constant layers and a third layer present only at the jugular level. From the inside out, the layers are as follows: 1) Inner Layer (Endothelium): This layer is clearer from the junction and reveals the presence of smooth muscle cells at the sigmoid level in immunohistochemistry. 2) Outer Layer: At the sigmoid and junctional levels, this layer consists of collagen fibers and becomes median at the jugular level, where it is composed of elastic and muscular collagen fibers. 3) Third Layer: Present only at the jugular level, this layer corresponds to the adventitia. Conclusion: The architecture of the sigmoido-jugular junction in fetuses, which is identical to that in adults, excludes the metaplastic hypothesis regarding endothelial smooth muscle cells in the sigmoid portion. Instead, it favors their role in regulating encephalic venous drainage.
文摘<strong>Objectives:</strong> Pulsatile tinnitus involves a wide spectrum of etiologies. The etiologies include normal vascular variants, temporal bone tumor, acquired vascular lesions and chronic middle ear inflammatory diseases. Jugular bulb diverticulum is a rare cause of pulsatile tinnitus. We report one case of jugular diverticulum presenting with pulsatile tinnitus and its surgical management and outcome. <strong>Case Report:</strong> A 36-year-old woman with a history of uterine myoma and chronic anemia presented with right pulsatile tinnitus that was worsening in recent one month. Neurological exam was normal. ENT evaluation revealed no abnormalities via otoscopy and physical examination. The CT scan revealed right dominant jugular bulb with diverticulum projecting to posterior ear canal wall. We performed jugular bulb diverticulum resurfacing with temporalis fascia, Surgicel<sup>®</sup> and Gelfoam<sup>®</sup>, and bone wax via transmastoid approach. The symptom improved postoperative immediately. No major complications were noted during outpatient clinic follow-up. <strong>Conclusion:</strong> Transmastoid resurfacing of jugular bulb diverticulum is an effective management of pulsatile tinnitus from this kind vascular anomaly.
文摘Lemierre’s syndrome(LS)is an uncommon condition with oropharyngeal infections,internal jugular vein thrombosis,and systemic metastatic septic embolization as the main features.Fusobacterium species,a group of strictly anaerobic Gram negative rod shaped bacteria,are advocated to be the main pathogen involved.We report a case of LS complicated by pulmonary embolism and pulmonary septic emboli that mimicked a neoplastic lung condition.A Medline search revealed 173 case reports of LS associated with internal jugular vein thrombosis that documented the type of microorganism.Data confirmed high prevalence in young males with Gram negative infections(83.2%).Pulmonary embolism was reported in 8.7% of cases mainly described in subjects with Gram positive infections(OR=9.786;95%CI:2.577-37.168,P=0.001),independently of age and gender.Only four fatal cases were reported.LS is an uncommon condition that could be complicated by pulmonary embolism,especially in subjects with Gram positive infections.
基金Project supported by the National Natural Science Foundation of China(Nos.81501644,81471623,81130007,81270446,and 30801188)the Key Science and Technology Innovation Team Project of the Science and Technology Department of Zhejiang Province(No.2011R50018-16),China
文摘Objective： The subclavian vein （SCV） is usually used to inject the indicator of cold saline for a transpul- monary thermodilution （TPTD） measurement. The SCV catheter being misplaced into the internal jugular （IJV） vein is a common occurrence. The present study explores the influence of a misplaced SCV catheter on TPTD variables. Methods： Thirteen severe acute pancreatitis （SAP） patients with malposition of the SCV catheter were enrolled in this study. TPTD variables including cardiac index （CI）, global end-diastolic volume index （GEDVI）, intrathoracic blood volume index （ITBVI）, and extravascular lung water index （EVLWl） were obtained after injection of cold saline via the misplaced SCV catheter. Then, the misplaced SCV catheter was removed and IJV access was constructed for a further set of TPTD variables. Comparisons were made between the TPTD results measured through the IJV and mis- placed SCV accesses. Results： A total of 104 measurements were made from TPTD curves after injection of cold saline via the IJV and misplaced SCV accesses. Bland-Altman analysis demonstrated an overestimation of ＋111.40 ml/m2 （limits of agreement： 6.13 and 216.70 ml/m2） for GEDVI and ITBVI after a misplaced SCV injection. There were no significant influences on CI and EVLWI. The biases of ＋0.17 L/（min.m2） for CI and ＋0.17 ml/kg for EVLWI were re- vealed by Bland-Altman analysis. Conclusions： The malposition of an SCV catheter does influence the accuracy of TPTD variables, especially GEDVI and ITBVI. The position of the SCV catheter should be confirmed by chest X-ray in order to make good use of the TPTD measurements.
文摘Background: The aim of this study was to evaluate the safety and feasibility of venous access via the internal jugular vein (IJV) for totally implantable venous access device (TIVAD) placements. In Japan, TIVADs are generally placed in position by the percutaneous subclavian vein puncture approach (SVPA). However, this approach causes infrequent intraoperative or postoperative complications. Using the internal jugular vein puncture approach (IJVPA), TIVADs could be placed more easily and safely. Materials and Methods: Fifty-six patients who received TIVADs for chemotherapy of colorectal carcinomas were enrolled in this study. The choice of approach (IJVPA or SVPA) was adopted at the discretion of each doctor in charge of the patient. The operation time, success rate and complications of the two approaches were compared and evaluated. Results: TIVAD placement was successful in all patients. Thirty patients received the device via IJV puncture, but 1 patient required conversion to SVPA. Twenty-six patients underwent SVPA for device placement, but 3 of these patients required conversion to IJVPA. Mean operation time was 34.3 min in IJVPA and 35.2 min in SVPA. The success rate was 96.6% in IJVPA and 88.5% in SVPA. No severe perioperative complications were observed. However, long-term complications were observed in five cases, 3 by IJVPA and 2 by SVPA, but no significant difference in the rate of complications was observed between these two approaches. A catheter-related thrombosis was found by CT scan in 3 patients, two of whom underwent IJVPA (6.7%) and one case underwent SVPA (3.8%). Two patients received simultaneous administration of bevacizumab. Catheter infections occurred in 1 patient who underwent IJVPA (3.3%) and 1 patient who underwent SVPA (3.8%). Conclusions: The IJVPA is a safe and feasible method for TIVAD placement.
文摘Neurofibromatosis type 1 is a congenital condition affecting neurons and connective tissue integrity including vasculature.On extremely rare occasions these patients present with venous aneurysms affecting the internal jugular vein.If they become large enough there presents a risk of rupture,thrombosis,embolization or compression of adjacent structures.In these circumstances,or when the patient becomes symptomatic,surgical exploration is warranted.We present a case of one of the largest aneurysms in the literature and one of only five associated with Neurofibromatosis type 1.A 63-year-old female who initially presented for a HincheyⅢdiverticulitis requiring laparotomy developed an incidentally discovered left neck swelling prior to discharge.After nonspecific clinical exam findings,imaging identified a thrombosed internal jugular vein aneurysm.Due to the risks associated with the particularly large size of our patient's aneurysm,our patient underwent surgical exploration with ligation and excision.Although several techniques have been reported,for similar presentations,we recommend this technique.
文摘BACKGROUND Grade II and III meningiomas[World Health Organization(WHO)classification]rarely have extracranial metastases via the blood circulation;however,we experienced a case with a metaplastic atypical meningioma and local dedifferentiation that metastasized to the jugular vein,carotid artery and subclavian artery at the cervicothoracic junction.Such cases have seldom been reported before.CASE SUMMARY The patient was a 30-year-old man who developed right neck masses with dysphagia,labored breathing,dizziness,and occasional earaches.Eight months earlier the patient was diagnosed with a right parietal lobe neoplasm and hemorrhage at a local hospital due to the sudden onset of headaches and left limb weakness,and the post-operative pathology was a metaplastic atypical meningioma(WHO grade II)with local de-differentiation(WHO III).Magnetic resonance imaging revealed a calcified mass at the root of the neck on the right and a large cystic mass in the right parapharyngeal space.Head and neck angiography showed that the right common carotid artery was compressed and completely occluded,and the jugular vein was enveloped by the tumor and occluded.A balloon occlusion test showed no perfusion in the right common carotid artery.Tumor resection,carotid artery ligation,and subclavian artery reconstruction were performed.The tumor was a malignant meningioma.Postoperatively,the patient had Horner's syndrome and hoarseness.CONCLUSION This case highlights the importance of the link between a large cervical mass and a primary intracranial tumor.Malignant meningioma should not be considered merely as an intracranial metastasis spread through cerebrospinal fluid,it can also be transferred through the circulation to the parapharyngeal space and the cervical great vessels.
文摘Observation: This patient was a 40-year-old housewife with dysphonia, physical asthenia, palpitations, fever and cervical tumefaction that had been going on for 2 months, no known cardiovascular risk factor, such as medical history, ischemic stroke. Heart sounds were regular at 110 bpm, blood pressure = 120/80 mmhg, to the lungs there are sibilant rattles. Elsewhere, there is a painful left lateral cervical tumefaction febrile to the touch. Temperature = 38°C. The rest of the exam is peculiar. Conclusion: Jugular vein thrombosis is a rare variety of unusual localization of venous thromboembolism. It must be suspected in the presence of a painful cervical swelling and confirmed by magnetic resonance imaging or to scan with contrast or ultrasound. Anticoagulant therapy should be instituted as soon as possible to avoid the formidable complication of pulmonary embolism.
文摘BACKGROUND Central venous catheter insertion is an invasive procedure that can cause complications such as infection,embolization due to air or blood clots,pneumothorax,hemothorax,and,rarely,chylothorax due to damage to the thoracic duct.Herein,we report a case of suspected thoracic duct cannulation that occurred during left central venous catheter insertion.Fortunately,the patient was discharged without any adverse events related to thoracic duct cannulation.CASE SUMMARY A 46-year-old female patient presented at our department to undergo cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.During anesthesia,we decided to insert a central venous catheter through the left internal jugular vein because the patient already had a chemoport through the right central vein.During the procedure,blood reflux was observed when the needle tip was not within the ultrasound field of view.We did not try to find the tip;however,a guide wire and a central venous catheter were inserted without any resistance.Subsequently,when inducing blood reflux from the distal port of the central venous catheter,only clear fluid,suspected to be lymphatic fluid,was regurgitated.Further,chest X-ray revealed an appearance similar to that of the path of the thoracic duct.Given that intravenous fluid administration was not started and no abnormal fluid collection was noted on preoperative chest X-ray,we suspected thoracic duct cannulation.CONCLUSION It is important to use ultrasound to confirm the exact position of the needle tip and guide wire path.
文摘Inflammation of a part or whole of the temporal bone and surrounding soft tissue is termed as malignant otitis externa,which typically spreads to skull base to involve cranial nerves VII.Rarely can it also effect one or more of cranial nerves IX,X,XI,and XII.We present a case of malignant otitis externa which presented with symptomatic palsy of IX and XII nerves sparing the VII cranial nerve.The patient though later on had internal jugular vein thrombosis,which we presume is due to the involvement of the parapharyngeal space that prompted us to reconsider the diagnosis,and later on,to aggravate the therapy.With proper blood sugar control and appropriate long term antibiotics,not only that the patient is disease free at one year follow up,but the cranial nerve deficits also recovered.Apart from sharing the clinical and management details of this patient,we have reviewed the relevant literature in the discussion,which has shed some light onto some of the interesting facts about this condition and its prognosis.
文摘Liposomes effectively transport fatty proteins to targeted tissues. Laboratory experiments use multiple methods to administer liposomes, but comparison of these methods is not available. In this retrospective study, we characterized and compared four intravenous administration routes (tail vein, jugular catheter, femoral vein and percutaneous retro-orbital injections) in murine models. ApoE<sup>-/-</sup> mice were used to compare administration routes. Results indicate that the jugular catheter route delivered the highest amount of liposomes to tissues due to longer period of injections compared to other routes;however, this route failed to remain patent for 8/10 animals. Delivery via tail vein, femoral vein and percutaneous retro-orbital injections resulted in similar accumulation in the organs. When including technical difficulty and expense, percutaneous retro-orbital injections of liposomes are the most convenient and efficacious approach.
文摘BACKGROUND Hemothorax is a rare but life-threatening complication of central venous catheterization.Recent reports suggest that ultrasound guidance may reduce complications however,it does not guarantee safety CASE SUMMARY A 75-year-old male patient was admitted for laparoscopic radical nephrectomy.Under ultrasound guidance,right internal jugular vein catheterization was successfully achieved after failure to aspirate blood from the catheter in the first attempt.Sudden hypotension developed after surgical positioning and persisted until the end of the operation,lasting for about 4 h.In the recovery room,a massive hemothorax was identified on chest radiography and computed tomography.The patient recovered following chest tube drainage of 1.6 L blood.CONCLUSION Hemothorax must be suspected when unexplained hemodynamic instability develops after central venous catheterization despite ultrasound guidance.So the proper use of ultrasound is important.
文摘Rationale:Thrombosis of the internal jugular vein is an infrequent and underdiagnosed pathology due to the absence of symptoms.If present,the symptoms are frequently manifested as a sensation of pain and cervical tension.Its etiology is variable,including trauma,central catheterization,and hypercoagulable states,among others.Patient’s Concern:A 41-year-old female,previously healthy,was admitted to the emergency room for worsening pain in the left cervical area of 5 d.Previously,she was treated for suspected acute pharyngotonsillitis yet without improvement.Diagnosis:Physical examination revealed a 2 cm in length cervical mass of hard consistency that was painful on palpation and non-fluctuating.Ultrasound study showed thrombosis of the left internal jugular vein.A computed tomography scan revealed that the thrombosis occurred at the cervical portion of the left internal jugular vein as well as the left transverse sinus.Interventions:Hospital admission and treatment with low molecular weight heparin at a dose of 1.5 mg/kg every 24 h.Outcomes:The patient was discharged after 3 d of treatment with vitamin K antagonists.Lessons:Venous thrombosis at the level of the internal jugular vein is an infrequent entity.Clinical suspicion is necessary for the diagnosis given the possibility of absence of symptoms.
文摘Background/Purpose: The right internal jugular vein (RIJV) is the most commonly accessed central venous site in the cardiac operating room. The Trendelenburg position is frequently used to increase the cross-sectional area (CSA) of the RIJV to facilitate its cannulation. However, the extent of change of RIJV CSA in response to Trendelenburg positioning in anesthetized patients and its predictive factors remain unknown. Methods: Thirty-seven patients presented for the cardiac surgery, and 20 ASA I and II surgical patients without a history of cardiac disease (control) were studied. After induction of anesthesia, RIJV CSA was measured both at supine level position and in 10-degree Trendelenburg using vascular ultrasonography. Central venous pressure was measured in cardiac surgery patients only, since the patients in control group did not require invasive lines placement. Results and Conclusions: Body-surface area, central venous pressure, type of surgery and ejection fraction did not show any correlation with the degree of RIJV CSA change. RIJV dilation in response to Trendelenburg was significantly less pronounced, and more variable, in female patients.
文摘Internal jugular vein (IJV) ectasia is a rare benign disease. It commonly presents as a unilateral, soft, compressible neck swelling that mostly involves the right side. It is usually a childhood disease and believed to be of congenital origin. Accurate diagnosis from careful history, physical examination and radiological study can be made. We report here two cases of IJV ectasia in African adults with right lateral neck mass dilating when increase intrathoracic pressure. Because of its rarity, this entity is frequently ignored or misdiagnosed. This case report intends to stress the importance of keeping IJV ectasia as differential diagnosis in mind in case of lateral neck swellings to avoid invasive investigations and inappropriate treatment. The asymptomatic case management of IJV ectasia is conservative with long-term surveillance.
