Enlarged jugular veins
Enlarged jugular veins
M. Boulaksil 0 1 2
R. M. M. Gevers 0 1 2
0 Department of Cardiology, Jeroen Bosch Hospital , 's-Hertogenbosch , The Netherlands
1 Acknowledgements We thank Dr. Marc Vorstenbosch, Associate Pro- fessor at the Department of Anatomy of the Radboud University Med- ical Center, Nijmegen, the Netherlands, for his critical appraisal of this manuscript
2 Department of Cardiology, Radboud University Medical Center , Nijmegen , The Netherlands
An 83-year-old woman presented to our emergency
department with a two-week history of progressive dyspnoea on
exertion and leg oedema, and no syncope. She had a
history of hypertension, diabetes mellitus type 2, renal
insufficiency, and left bundle branch block.
She was clinically mildly decompensated. The ECG
showed sinus rhythm with total AV block and a
ventricular escape rhythm of 30/min. Echocardiography showed
normal left and right ventricular systolic function and a
dilated inferior vena cava with decreased variation.
During pacemaker implantation, a remarkable anatomy
of the jugular veins was noticed. An aberrant trajectory of
the wire was perceived from the left subclavian vein to the
contralateral side (Fig. 1a and online video). After contrast
injection, two large veins were observed running parallel to
one another which were connected caudally (Fig. 1b).
Furthermore, the left brachiocephalic vein and superior vena
cava (Fig. 1b and 1c) are appreciated.
We concluded that the anatomy consisted of enlarged
anterior jugular veins (venae jugulares anteriores) and a
jugular arch (arcus venosus juguli) . This is a common
anatomy, but these jugular veins are rarely enlarged .
Probably, this has to do with the increased venous pressure
due to backward heart failure.
Conflict of interest M. Boulaksil and R.M.M. Gevers declare that they
have no competing interests.
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Fig. 1 a Chest radiography showing a guide wire (arrow head) running horizontally from the left subclavian vein to the contralateral side. b An
overlay of sequential chest X-rays showing a phlebogram of two anterior jugular veins running parallel (venae jugulares anteriores) which are
connected caudally by a jugular arch (arcus venosus juguli). See also the online video
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