Can you review my CTA/CTV?

[emaz]

Hi all! I ended up going to the ER last night because my symptoms had escalated so much. They did a cta/ctv but told me that there’s no way that I have eagle. I just did a 3D scan and I believe I have Eagle on my left side. I’m wondering if you all could take a look and tell me what you see? I’m sharing a google drive link here with photos just in case mine don’t upload here. CTA and CTV 3d render - Google Drive

I appreciate you all so much!

Em

Left side photos (I believe side with Eagle)

Right side photos (no issues on my right side)

[MGORNEAU]

@emaz Because they are experts on Eagle at the ER

Do you have the actual DICOM set? If I’m not mistaken, the best way to assess the relationship between the styloid and the vascular structures is on the source images themselves, especially the axial images, because 3D reconstructions can distort or exaggerate spatial relationships.

That said, this styloid does look potentially significant to me. Without orientation labels, I would presume this is the right styloid. It appears fairly long and thick and seems to angle medially toward the vascular structures, although it’s hard to tell exactly how close everything is from the 3D reconstruction alone.

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[Isaiah_40_31]

@emaz - Were your images done dynamically i.e. w/ your head in different positions or was it kept in neutral during the whole scan process?

You have a fairly long & somewhat thick styloid on the left side & a thick chunk of calcified stylohyoid ligament on the right. It’s interesting that only a small portion of your IJV shows up in your images of the left styloid, but your internal & external carotid arteries are there. Your right side images show your right IJV & carotids. Do you have some left side pics that also show more of the IJV? The good news is it looks like you have a lot of space between your left & right styloids & the transverse process of C1 on both sides. However, it appears you may have slight IJV compression on the right, starting at the level of C2.

The other concern I have is the “spike” that sticks up off your calcified thyroid cartilage which could be bumping into your hyoid bone. In some images it looks like they’re touching, but in others, it looks like there’s a good amount of space between them - probably just the angle of the image that makes the difference. I’m only mentioning this because it is something you may want to point out to whomever you have consults with to get an opinion as to whether or not it’s a problem.

[Isaiah_40_31]

@MGORNEAU - @emaz labeled the images, & they are mirror images of right & left i.e. the one you posted is the left side. I had to re-read her post a few times to figure that out.

[emaz]

Hi @MGORNEAU and @Isaiah_40_31 ! I totally biffed it and got my left and right confused lol. I do have the dicom files and they were completed statically. Can I connect with one of you for support? I couldn’t figure out the 3d slicer and the other dicom viewers I found online weren’t incredibly helpful.

Thank you so much for the support!

Em

[Filya]

@Filya

It would be nice to look at the CT scans. You can post Dicom images right here on the forum, but only anonymously via this website: www(dot)dicomlibrary(dot)com/ If you wish for it yourself, you can send CT (Dicom) images via Google drive to my personal email (filatovtech@gmail.com or filatovtech@mail.ru ). I also want to inform and warn you-to explain : The CT scans contain your personal information, such as last name, first name and date of birth, and you understand that you will share your personal information with me by sending me these CT scans by email. It’s up to you whether to send the CT scan images or not.

All CT scans must be uploaded in DICOM format. Some (certain) photos and CT scans are not informative; based on some CT scans, it is impossible to make any confident statements or draw any conclusions. There is no need to engage in speculation or fantasy based solely on a few photos and CT scans.

look up(quote) this need Dicom files. What were the symptoms? It’s more like ICA compression with the hyoid bone. But it can only be assumed more precisely based on Dicom CT files (all images and all three projections . 3 D visualization won’t show much)

[Jules]

@Filya

t’s more like ICA compression with the hyoid bone

I think this looks like a possibility too, in some of the images the hyoid processes are very close…

@emaz what were the symptoms which were bad enough to take you to the ER? I hope that you’re doing better today, & don’t believe what they said about not having Eagles!

[emaz]

Hi @Filya and @Jules ! Thank you both so much for all your support. Filya, I will email my DICOM files right now and I’m totally okay with you having my personal info (thanks for checking!).

Here’s some more info that might be relevant. In October 2025, I was diagnosed with IIH in my left transverse/sigmoid sinus junction area. Normally to get a stent you need a pressure gradient of 8-10. I had a gradient of 41, which my doctor told me was the highest she had ever seen in her career. I got a stent in late April, and this can be seen on my scans.

While treating my IIH, I was on the max dose of meds - 4,000 mg of diamox, 150mg of topirimate, and 80mg of lasix. After I got my stent placed, I’ve slowly been coming off all of those meds. I was just down to 500mg of diamox and I’m still on plavix and aspirin while my stent is healing.

After I got my stent, I started noticing problems with the left side of my neck and throat immediately. I would have stabbing pain in the back of my throat on the left side, neck pain, problems swallowing, and more (I’ll put full symptom list below). However it kind of calmed down a bit and the problems felt relatively mild. The biggest symptom I was still having was a “migraine” that would start in my left occipital and would travel to the left temple. I had no solutions for this.

About two weeks ago, I decided to go up on diamox to see if that would make my headaches better as I was getting them every 3-4 days. The only time I had ever been migraine free was when I was on 4000mg of diamox. I went from 500 to 1000 and it helped. I then went up to 1500. However, within the last week I’ve noticed that my symptoms were getting worse to the point where I felt I needed to go to the ER.

These symptoms were mainly around pressure on the left side, specifically around my neck. The pressure increased so much I thought I was going to have a stroke or something. I had severe throbbing and pulsatile tinnitus, my migraines were severe and lasted for days. I also had awful neck pain and nerve pain in my neck and left side of my head, and back two molars on my left side. I had shoulder pain and nerve pain there as well. I noticed that I couldn’t turn my head to the left without exacerbating my symptoms and I also can’t bear down or strain to where it puts pressure on those arteries/veins. That creates severe pain that travels in a path from my jaw near my ear, across my neck, and lands in the front by the middle of my throat on the left side.

I am now on 2,000mg of diamox, 75mg of plavix, 81mg of aspirin. The diamox is the only thing that is allowing me to function. Any help you all can provide is VERY appreciated!!! I’m so grateful to you all!

Em

Full list of symptoms:

• “Crunch” when I swallow
• Left sided symptoms only, right side feels fine and has normal pressure
• Sinus and eye pressure on the left side, neck / jugular pressure
• Throat tightness, strangled feeling, can’t swallow sometimes
• Intermittent stabbing pain on left side in back of throat
• Left ear fullness, pulsatile tinnitus, and ringing tinnitus
• Left sided “migraine” - starts in occipital region/upper neck and then goes to left temple. These decrease in frequency and intensity the higher up I go on diamox
• Muscle pain in left neck
• Eye pain and strain, especially with light and small print. Get pain behind eyes a lot
• Some vertigo and dizziness
• Neck pain on left side. It almost feels muscular but like its deeper and like I’ve got an injury. I can’t turn my neck without it hurting
• Can’t bear down or strain without pain
• Brain fog, fatigue (could be diamox dose)
• Intermittent blurry vision in left eye
• Tooth pain - second molar on bottom left, nerve pain
• Nerve pain on left side of face, head, some arm and shoulder nerve pain too
• Tinnitus - both pulsatile and ringing
• Nausea
• Predictable pressure increases - orthostatic changes, turning head, exercise or activity
• Throbbing head sensation on left side

[MGORNEAU]

@emaz if you haven’t tried it yet, RadiAnt DICOM Viewer has a free trial, but it is Windows only. I find it really easy to navigate, and I believe the trial is 45 days. I ended up paying for the monthly subscription because it’s pretty reasonable. Website: RadiAntViewer.com

I’m definitely not highly experienced at reviewing imaging — novice at best — but I do find it really interesting to scroll through my own scans. If you’re naturally curious and want an easy way to look through the actual DICOM images yourself, I’d recommend giving RadiAnt a try, it has the 3D conversion tool as well.

[emaz]

Thank you SO much @MGORNEAU !!! I just used it and it’s great. Here’s something I noticed:

Right styloid (in yellow) - it’s long but there’s a lot of room around it and it’s not touching anything else. I don’t have symptoms on this side.

Left styloid (in yellow) - my syloid here isn’t as long but it’s touching and pressing on my IJV. My IJV is a lot bigger on this side and there isn’t a lot of room at the top where it’s coming out.

Here’s a wider pic comparing the two sides.

Right side

Left Side

[MGORNEAU]

@emaz Nice job getting RadiAnt working! These views are definitely useful. Both styloids look fairly long to AI, and they sit quite close to the upper cervical vascular structures. The relationship that would be helpful, especially on your symptomatic left side, is the space between the styloid, internal jugular vein and C1 transverse process.

If you can post a few axial slices through C1/skull base, preferably with the vessels visible, that should tell us much more than the 3D reconstruction about whether there is actual compression. This is about the level I’d start at. If you can, post several consecutive axial slices from here downward through C1 so we can see the styloid, jugular vein and C1 transverse process relationship. The tightest compression may be a little lower than this exact slice. Then hopefully @Isaiah_40_31 will jump in to annotate!

If that doesn’t make sense just let me know. I can highlight some of the structures to look for as a starting point.

[emaz]

Here are some photos. Let me know if you need more. Thank you so much @MGORNEAU and @Isaiah_40_31 !

[MGORNEAU]

@emaz These axial views are much more helpful. To me there looks like quite a bit of crowding around the jugular/styloid/C1 region on both sides, not just the symptomatic left. The degree seems to change from slice to slice, which is why reviewing the full axial stack is important. I’d definitely make sure whoever evaluates this looks at both sides even though your symptoms feel predominantly left-sided.

Also, it may not be as simple as all symptoms coming from one side. Different symptoms could potentially be coming from different sides depending on which vascular or nearby structures are being affected. Things like vertigo, dizziness, brain fog, nausea and head pressure especially may not localize neatly to one side.

I don’t know how to annotate so hopefully @Isaiah_40_31 jumps in

[Isaiah_40_31]

Sadly, reading axial images isn’t my forté, however, I have annotated the axial image at C1. I’m not convinced my labels are correct, however, it doesn’t look like there is IJV compression on either side at the level of C1. In the 3D images, @emaz doesn’t appear to have any collateral veins above or below her C1 vertebra which gives some credence to lack of IJV compression at that level, however, her symptoms indicate there is compression somewhere. I’m sorry I can’t be more helpful with the axial images.

Hopefully someone who is more experienced reading them - @Filya ? or @Emerald ?- could give their opinions.

[emaz]

Thank you @Isaiah_40_31 ! The thing I’m noticing about my left IJV is how much bigger it is compared to my right one. I feel a huge amount of swelling when I touch it. I’m wondering if it might not be Eagle’s but something else that is contributing to a swollen / distention of my IJV there at the top. You can really see the difference in the 3D images.

Thank you for your help!

[Isaiah_40_31]

It’s not unusual for one IJV to be substantially larger than the other, however, if your left IJV feels swollen to the touch, there could be something else going on as you suggested. I hope we can help you find the best doctor to solve the mystery of what’s going on w/ your IJV.

[Jules]

I think looking at the axial imaging, the left IJV looks pretty good at the C1 level, but the right side is smaller. Often there is one IJV naturally smaller, and one more dominant, so I presumed this was the case, but If you track the IJVs further down through the slices, the right IJV gets larger further down, so it could be compressed here at the C1 level. And the left IJV which looks fairly big at C1 level gets a bit smaller lower down, by Axial slice 5 onwards?

Looking at the sagittal view , there looks to be flattening of the IJV in the 3rd image at the hyoid level, possibly by the carotid artery? Which corresponds to the IJV looking smaller in the axial imaging…

It certainly sounds like you have nerve related symptoms from ES as well as vascular ones, so worth pursuing ES as a diagnosis!

[Emerald]

@emaz. Your clinical symptoms do suggest a vascular compression/nerve irritation but have you seen an ENT to rule out some type of salivary gland problem on the left hand side. Maybe it is the salivary gland on the left you are feeling and not your left internal jugular. It could explain also why the left dominant internal jugular is smaller in axial 10 due to pressure from a swollen salivary gland (the large dark area on the CT scan).

[Filya]

I looked at the images for about 20 minutes this morning, which is not enough time to fully study the CT scans.It takes a couple of hours, it’s difficult.

And what i find:

Please send a confirmation response: did you receive the email with the CT scan images? You can share this information on the forum.

1)So in the neck itself , there is no compression of the veins /IJV (except for a slight compression of the brachiocephalic vein between the arch of the aorta and the scapula of the sternum . But it’s not critical, and it hardly affects anything.). Your IJVs are a little thinner than usual due to transverse venous sinus hypoplasia. After entering the facial veins, your IJVs expand (groan thicker)

2. Do you have problems with transverse venous sinuses (with jugular foramen in the skull) The jugular foramen is small because it is congenital (present at birth, an anomaly) or due to skull trauma. Your right transverse sinus is very heavily hypoplasmic (jugular foramen in the skull small 2,5x1,5mm). And it looks like there’s a stent in the left one.

3. You have styloid processes. But they are more likely to cause only pain and problems with swallowing (dysphagia). The styloid processes are not associated with venous compression (except for the indirect (muscle) slight compression of the left IJV). the left IJV is slightly compressed, but not critically (muscle or lymph node). It looks more like a dislocated digastric muscle due to the styloid process. But I don’t think it affects anything , there is no significant compression.

The main problem with veins is hypoplasia of the transverse venous sinuses.

You need to develop venous collaterals (vertebral veins). Neck massage (light) , relaxation of neck muscles. Yes, symptoms maybe. But I can’t say for sure that transverse sinuses were the main reason you went to the ER. (emergency ambulance). What were your symptoms? Perhaps the main problem is with the arteries.

4) I think it has more to do with your vertebral arteries (they are tortuous/curved and very thin at the very beginning/source). It is also impossible to exclude the possibility (although unlikely) of dynamic compression of the internal carotid artery by the styloid process or hyoid bone.

5) Do a DSA arteriography (of the vertebral arteries and CCA, ICA) with dynamic tests such as head rotation and look at the entire artery path.

[Filya]

As for the styloid processes and pain, and problems with swallowing. You can remove the styloid process. In your case, the CT scans show that it will be enough for you to remove only the styloid process (you do not need to shave C1 and remove the digastric muscle). But removing the styloid processes will solve only part of the problems, mainly pain and swallowing problems. The remaining problems with the arteries and transverse venous sinuses, the removal of the styloid processes processes will not solve. (It won’t solve all your problems (symptoms) in any way)