Bilateral duplicated internal jugular veins: Case study and literature review

Abstract

A rare bilateral duplication of the internal jugular vein (IJV) was discovered during cadaveric dissection. From each jugular foramen, a single IJV descended to the level of the hyoid bone then divided into medial and lateral veins. The medial IJVs traveled in the carotid sheath; the lateral IJVs coursed posterolateral to the sheath across the lateral cervical region (posterior triangle) of the neck. On the right side, medial and lateral IJVs entered the subclavian vein separately. C2-C3 anterior rami and the suprascapular artery passed between the medial and lateral IJVs. The right external jugular vein passed aberrantly between the heads of the sternocleidomastoid muscle (SCM) into the subclavian vein anterior to the lateral IJV. On the left side, the medial IJV drained into a large bulbous jugulovertebrosubclavian (JVS) sinus that received six main vessels. The lateral IJV diverged posterolaterally toward the border of the trapezius muscle, received the transverse cervical vein, and then turned sharply anteromedially to drain into the JVS sinus. The lateral IJV also gave an aberrant additional large vein that passed laterally around the omohyoid muscle before entering the JVS sinus. The left external jugular vein paralleled the anterior border of SCM before passing posterolaterally to terminate in the JVS sinus. Jugular vein anomalies of this magnitude are very rare. Determining the frequency of multiple IJVs is hampered by inconsistent terminology. We suggest that IJV duplication differs from fenestration anatomically and, potentially, developmentally. Criteria for characterizing IJV duplication and fenestration are proposed. The mechanism of development and the clinical significance of multiple IJVs are discussed.

An extraordinary fenestration of the internal jugular vein: multidedector computed tomography findings

“…The main difference between these two clinical conditions is that in duplication, the IJV that comes as a single vessel from the foramen jugulare bifurcates superiorly and communicates with the subclavian vein distally as two distinct Fenestrated IJVs frequently occur with phlebectasia (local fusiform venous dilatation), which appears as a non-pulsatile cervical swelling that enlarges during the Valsalva maneuver. While abnormalities such as aneurysms and arteriovenous malformations accompany arterial fenestrations, they are rare in venous fenestrations (1)(2)(3)(4)(5). Phlebectasia or aneurysm(s) accompanying fenestration was not observed in our case.…”

“…It proceeds in the carotid sheath together with the common carotid artery before combining with the subclavian vein on the sternal side of the clavicle. The IJV is a significant landmark that is encountered during dissection of the cervical lymph nodes in oncological surgery, central venous catheter insertion, and interventional radiological procedures; familiarity with the probable anatomical variations of the IJV and those of its neighbouring structures is important (1)(2)(3). In this report, a male patient, in whom quite a large extraordinary fenestration was detected in the left IJV during multidetector computed tomography (MDCT), is presented in the light of MDCT findings and the literature.…”

Duplicated Internal Juguler Vein

“…The anatomical course of the jugular veins is usually very consistent; however, anomalies do occur, which may present as a neck swelling or be an subclinical finding [2,3]. Downie et al [4] previous reports of IJV anomalies have used the terms 'duplicated' and 'fenestrated' interchangeably. The main difference between these two conditions is that duplicated IJVs comprise two separate branches along the whole length of the normal pathway, whereas in fenestrated IJVs the two branches reunite before draining into the subclavian veins.…”

A Case of Unilateral Fenestration and Duplication of the External Jugular Vein

“…Divisions (fenestrations or duplications) of the IJV are estimated to occur in as much as 0.4% of the population (Prades et al, 2002). In order to avoid confusion between the terms duplication and fenestration, which are used interchangeably in the literature available, Downie et al, (2007) suggested that the term duplication be limited to those cases in which the branches of the anomalous vessel remain separate over the entire course, whereas the term fenestration should be used for those cases in which the branched vessel reunites into a single normal vessel.…”