EURORAD ESR

Case 9897

Ultrasonic evaluation of internal jugular veins in multiple sclerosis

Author(s)
Oreste D, Pavone S

Via Giulio Petroni 120, 70124 Bari (BA), Italy;
Email:donato-oreste@libero.it
 
Patient
female, 35 year(s)
 
 
  • Figure 1
    Annulus

    Wall thickening of the middle segment of the left IJV (arrows) with stenosis. Unlike collapsing veins (a common ultrasonic finding) due to the low blood pressure, annulus consists in an alteration of the wall thickness.

     
    Area of Interest: Cardiovascular system; Imaging Technique: Ultrasound; Procedure: Physiological studies; Special Focus: Obstruction / Occlusion;
     
     
  • Figure 2
    Intraluminal membrane

    Near the jugulo-subclavian junction, please note the presence of an hypomobile membrane (between points) with exclusion (star) from perfusion of a part of vessel lumen.

     
    Area of Interest: Cardiovascular system; Imaging Technique: Ultrasound-Power Doppler; Procedure: Physiological studies; Special Focus: Obstruction / Occlusion;
     
     
  • Figure 3
    Hypomobile valve
     

    Distal segment if the right IJV. During the maximum openness of the valve, please note the hypomobility of the leaflets (arrows), witch creates a virtual stenosis.

     
    Area of Interest: Cardiovascular system; Imaging Technique: Ultrasound; Procedure: Physiological studies; Special Focus: Obstruction / Occlusion;

    The Power Doppler evaluation confirms the virtual exclusion from blood flow of some parts of the jugular lumen (points) due to a not complete opening of the valve leaflets.

     
    Area of Interest: Cardiovascular system; Imaging Technique: Ultrasound-Power Doppler; Procedure: Physiological studies; Special Focus: Obstruction / Occlusion;
     
     
  • Figure 4
    Carotid artery kinking

    Carotid Artery (CA) kinking compresses (arrows) the middle segment of the Internal Jugular Vein (IJV) creating long period of blood reflux both in supine and in upright position.

     
    Area of Interest: Cardiovascular system; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Physiological studies; Special Focus: Obstruction / Occlusion;
     
     
  • Figure 5
    Intraluminal septum

    Septa consist in embryonic residuals stretched on both sides of the vein. Rotating the probe on its own fulcrum a separation in two or more leaflets is never demonstrated.

     
    Area of Interest: Cardiovascular system; Imaging Technique: Ultrasound; Procedure: Physiological studies; Special Focus: Obstruction / Occlusion;
     
     
  • Figure 6
    Intraparenchymal collaterals

    In this patient with a severe hypoplasia of the left IJV, the PD evaluation demonstrates the activation of intraparenchymal collaterals of the thyroid veins.

     
    Area of Interest: Cardiovascular system; Imaging Technique: Ultrasound-Power Doppler; Procedure: Physiological studies; Special Focus: Obstruction / Occlusion;
     
     
  • Figure 7
    Blocked flow

    No flow signal detected in this patient with stenosis of one IJV. PRF is set to the low value of 0.7 MHz. Note the very low haematic flow speed which creates concentric "waves" in the lumen.

     
    Area of Interest: Cardiovascular system; Imaging Technique: Ultrasound; Procedure: Physiological studies; Special Focus: Obstruction / Occlusion;
     
     
Wall thickening of the middle segment of the left IJV (arrows) with stenosis. Unlike collapsing veins (a common ultrasonic finding) due to the low blood pressure, annulus consists in an alteration of the wall thickness.
 
Near the jugulo-subclavian junction, please note the presence of an hypomobile membrane (between points) with exclusion (star) from perfusion of a part of vessel lumen.
 
Distal segment if the right IJV. During the maximum openness of the valve, please note the hypomobility of the leaflets (arrows), witch creates a virtual stenosis.
 
The Power Doppler evaluation confirms the virtual exclusion from blood flow of some parts of the jugular lumen (points) due to a not complete opening of the valve leaflets.
 
Carotid Artery (CA) kinking compresses (arrows) the middle segment of the Internal Jugular Vein (IJV) creating long period of blood reflux both in supine and in upright position.
 
Septa consist in embryonic residuals stretched on both sides of the vein. Rotating the probe on its own fulcrum a separation in two or more leaflets is never demonstrated.
 
In this patient with a severe hypoplasia of the left IJV, the PD evaluation demonstrates the activation of intraparenchymal collaterals of the thyroid veins.
 
No flow signal detected in this patient with stenosis of one IJV. PRF is set to the low value of 0.7 MHz. Note the very low haematic flow speed which creates concentric "waves" in the lumen.
 
 
 
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