Hi,
I uploaded my CTV scan into Radiant.
Clicked some buttons and was able to render these images.
Do they show IJV compression?
If yes, is it moderate or severe?
Compression from C1 or styloid or artery/muscle?
Thanks!!
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@chrEagle really hard to draw any strong conclusions from the 3D models. The best view is the axial view.
If you want, I could take a look through the entirety of your imaging for you. Members typically put their CT files into a google drive folder and then private message me a link to the folder. That way I can download the imaging and go through it all. Let me know if this is something you’d be interested in. You’d no longer be anonymous to me, but I wouldn’t be sharing any of your personal information.
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Thank you so much. Yes, I will put my images in a google drive folder – I have soft tissue and bone images. CTV neck with contrast from the TS junction to clavicle.
I will message you when images are uploaded. Thanks again!
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I can’t see your styloids at all on those images, nor the C1 processes, so can’t comment, the IJVs look fairly full but it can look very different on the axial views as @TML says. I would say though that your neck looks like it’s lost it’s natural curve- aka military neck- which we see quite often. This could be contributing to a forward head posture which may make symptoms worse, or it could be it’s your body’s way of trying to open up the space in your neck, it’s one of those dilemmas we don’t know the answer too! But there are exercises which you could try in this post:
List of my favourite resources on YouTube to learn anatomy - General - Living with Eagle
@TML will hopefully look at your images down to your hyoid, it’s probably clearer in the axial view, but it looks like your hyoid might be against the IJV on your left side?
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@chrEagle see attached annoted images (5 here of the axial view, and a 3D model in a following post)
Between the skull-base and C1, your left styloid comes in contact with your left IJV. Contact is normal, compression is not. I would be surprised if this contact is causing any symptoms.
Further down, at the level of C1, there is some compression of your left IJV against C1. Neither styloids are contributing to any compression here.
At the level of C2ish, your left IJV becomes compressed by your left ICA. Your ICAs are tortuous, in that they move from an anterior to posterior position and then go back to anterior position. On it’s way to to the posterior position, the left ICA compresses your left IJV.
There is no other IJV compression anywhere.
Further down, there is a pocket of calcified stylohyoid ligament on both sides. It may not look like much, but these little calcification pockets can irritated nerves.
Further down, your thyroid cartilage is in contact with you CCAs. This can commonly occur, but this positioning could cause symptoms when turning your head because the SCMs contract and could push the CCAs harder against the thyroid cartilage. Symptoms would most likely include pain the radiates up the sides of the neck and down into the top of the chest.
Just a reminder that I am not a doctor nor radiologist. Hope this helps.
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@TML, Thanks so much for looking at my scans. Very helpful!
Is the left IJV compression by the left ICA moderate or severe? Can this cause symptoms? My jugular doppler did show very low velocities in the left IJV. I don’t have symptoms on the left.
I have pulsatile tinnitus on the right hand side with jugular doppler showing much higher velocities. Maybe contralateral flow from the blocked left side to right side is causing turbulence on the right and pulsatile tinnitus?
Thanks!
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I can’t really comment on the severity of the IJV compression due to the ICA. The amount of IJV compression required to cause symptoms differs in everyone (which is why radiologists usually show no concern over IJV compression, even though they should because everyone is different). All I can say is that the diameter of your left IJV lessens when the ICA contacts it. Unless there is what I deam as “extreme” compression (e.g., styloid compresses IJV against C1 to a sliver) than it’s hard to say what’s moderate vs severe vs minimal. I think it’s possible that the left IJV compression by the ICA is capable of causing problems. A surgeon should be able to move the ICA so it’s course doesn’t interfere with the IJV.
I will add that IJV compression usually causes increased velocity (think about putting your thumb over the nozzle of a hose - the diameter of the opening is lessened but the speed the water comes out is faster), so it’s odd to me that your left IJV had lower velocities given the compression from the ICA. However, the upper half of your right IJV is smaller in diameter than your left IJV, which may explain why the velocity is faster in the right. Almost every CT I’ve seen had a dominant and non-dominant IJV.
There’s always the pesky jaw to consider as well. TMJ irritation can cause ear-related symptoms. So if you have jaw pain in the TMJ that should always be considered too.
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