CTA: What is this vein?

[Rather_b_hiking]

Upon looking at the 3D view of my CTA, I noticed what appears to be a fairly large rogue vein going down the back of my neck, well outside of the spine (Large red arrow). I can’t seem to find anything on it, except that it may be the posterior external jugular vein. However, the PEJV drains into the main external jugular, and this vein seems to go down very far, and I can’t actually see what it connects to in the end. Also note the thinness of my left jugular at the C1 (left arrow), you can actually see the styloid through it, and my neck is all sorts of crooked. (blue arrow). Anyone have any ideas??? The radiology report didn’t mention it.

[KoolDude]

@Rather_b_hiking That is a collateral vein (Posterior Condylar Vein connects to Vertebral Venous Plexus and drains all the way down to Brachiocephalic vein/Subclavian Vein). Sometimes it is called deep cervical vein and it is an alternate route to drain the brain when your jugular veins are impaired. It is dilated because blood is rerouted to it since the right Jugular vein is compressed - tale-tale sign of IJVS. I captured some diagrams and explanations on the link below if you need more details on it.

CT Scan Pics, broken styloid or scan error? Compression?

@blistle Well, based on your symptoms and limited imaging you provided, I can safely assume, you are suffering from Internal Jugular Vein Stenosis (IJVS) symptoms. This, I think is due to compression of the Styloid fragment on your right IJV and since your left IJV is small and is also compressed by the C1, it can’t compensate it. I think your symptoms are so similar to mine (see here Visual snow and floaters - #4 by KoolDude), no surprises there because your IJVs are like mine, just the opposit…

[Jules]

Will be good to get those styloids out!
Thanks @KoolDude for the explanation, I wouldn’t have had a clue

[Rather_b_hiking]

thanks @KoolDude - I knew you’d have the answer! It makes a lot of sense - I love these 3D reconstructions, that vein just pops out at you. I figured it was an enlarged collateral vein I just wasn’t sure which one. It’s wild that it is so enlarged while lying down - I can’t imagine what happens when I’m standing. And thanks for the links, that’s some pretty cool stuff.

And yes, I will be so grateful to get these out - hopefully it takes care of most of the compression problems. I do seem to have some instability and hyper-mobility of my cervical spine, so I hope that the C1 doesn’t keep causing problems once the styloids are gone.

[Isaiah_40_31]

Thank you for coming to our rescue @KoolDude! I was in the same boat w/ Jules. Your clarifications are always so helpful!

[Isaiah_40_31]

I hope for surgery to make a huge difference for you, too. I’m wondering if strengthening neck muscles to support your cervical spine would help stabilize your neck? That would be something to look into post op.