I didn’t think they were with contrast but maybe it was with and without and I the one I sent early was one without?
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nope the one I sent prior was the CT Face, these are the CT Neck
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Can you upload an image of the axial view of C1 for this neck CT with contrast like you did previously for the one without contrast? I can check IJV compression that way
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I double checked and these images are from a non-contrast CT. Below are a couple of examples from the CT Neck Axial View.
I had asked AI why the veins appear on a 3D reconstruction without contrast, and this was the explanation:
· The software reconstructs based on tissue density differences. Even without contrast, veins (and arteries) can appear as soft-tissue density structures in their expected anatomical course.
· What we are seeing isn’t “contrast filling” the veins — it’s the rendered outline of the soft-tissue channels where the veins sit.
· These often look darker or more translucent than bone because the reconstruction assigns different opacities and colors to different density ranges.
So the veins in these images are really anatomical placeholders. You can see their outlines in the right position, but you can’t judge whether the lumen is narrowed or compressed unless the vessels are opacified with contrast — which is why a venous-phase CTV is still needed.
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@MGORNEAU this makes sense. Given that we have the CT with contrast, are you able to 3D reconstruction it so we can see the arteries in the 3D model as well? I can see the ICAs and IJVs in the axial view of this CT so if you do a 3D model of it we will be able to see your ICAs/ECAs as well in addition to your IJVs in the 3D model. I’ll annotate the axial view shortly
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unfortunately both my CT neck from 2022 and 2023 are without contrast as well. The only CT imaging I have with contrast is a CT Angio thoracic outlet which I don’t believe helps to show styloids. My PCP at the time never ordered with contrast, he thought it would be denied by insurance which was not the case at all. National Imaging (now Evolent) could have cared less if it was ordered with or without contrast.
I have my imaging on Inteleshare recommended by the second opinion (Included Health) and found a CT Head from 2020 with CONTRAST! not sure it will mean anything but here are the first three slices including the C1. I had gone to the ER in excruciating pain, nothing found! Fast forward 1 1/2 years and I had a saliva stone come out, which is what lead to the sialendoscopy and the discovery of the blocked saliva duct. I will use the radiant to see if it sees anything useful. Unfortunately it doesn’t go further down into the neck and this is from 2020.
This CT has contrast:
Both IJVs and both ICAs are very visible. So if you can open whichever CT this is in radientviewer and 3D construct it we should be able to see the ICAs and IJVs in the 3D model
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that is the head CT with contrast and this is what comes up in 3D. The CT Angio for TOS is in contrast and shows more, will send along shortly
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okay last try, these are from the CT Angiogram 5/22 with Contrast and 3D for right side only, left side only started presenting with symptoms in September last year
@MGORNEAU see attached annotated imaging.
Both your IJVs are pretty open at the level of C1. Much more than we usually see so that’s good. Your right styloid does touch your right IJV so it’s possible compression occurs with certain head positions. Both IJVs are against C1 which is pretty common and the compression isn’t too bad as far as I can tell. If you are having any intracranial hypertension symptoms, I think the IJVs must be getting compressed elsewhere. Do you get intracranial hypertension symptoms or is it mainly pain/nerve irritation from the elongated styloids?
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Ohhh that makes sense
Oh its vascular, it has been progressing for a long time, those images are from 2022-23. The Stanford Neurosurgeon saw the compression on the MRI Cervical spine 2025. I can send some pictures of my neck and the visible vascular congestion (which is positional) of what it is doing but I don’t want to offend anyone.
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@MGORNEAU No one is likely to be offended by pictures you post. If they are bloody/graphic, sending them in a link vs posting them outright is an idea. We’ve seen quite a variety of pictures on here.
I’m sorry I can’t tell you how long your styloids are. I don’t know how to measure them. I think there’s a tool for doing that in the 3D slicer programs. There’s an annotated image below so you can see what you should measure. I can say that your styloids are quite long & @TML’s guess at the lengths is likely close to accurate. Also bear in mind that CT slices have tiny spaces between them so even if you measure what you can see, the measurement will only be approximate. Your styloids are likely a bit longer than the imaging shows.
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I wouldn’t worry too much about the styloid measurements; as @Isaiah_40_31 says it’s not particularly accurate with CTs, & they’re obviously elongated…
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I saw Jules’ post but out of curiosity I used RadiAnt’s measurement tool — both styloids measure around 5 cm.
Below is the list of symptoms I included with my second opinion. I know the face and throat issues are classic for Eagle, but I’m curious if other members have also experienced vascular congestion and jugular vein prominence.
Key Symptoms (as submitted for my second opinion):
· Persistent and worsening occipital and upper cervical head pressure (right side)
· Crushing pressure at the back of the head while upright, worsening through the day (right side)
· Facial pressure and nerve pain, jaw tightness, tongue tingling, muffled sensation in ear (right-sided, recently intermittent on the left as well)
· Right-sided neck and facial swelling, with new left jugular vein prominence and visual pulsing
· Flattening of the inspiratory flow-volume loop on PFT (possible extrathoracic airway obstruction)
· Episodes of shortness of breath, intermittent voice loss, difficulty swallowing, and constant chest pressure
· Bilateral arm/hand tingling, occasional weakness, right-sided scapular pain
· Visible vascular congestion and skin discoloration in arms/legs while sitting upright
· Significant positional relief of lightheadedness and pain when lying down/reclining, with notable blood pressure drop while supine
Here are some photos showing the vascular congestion I mentioned. The neck images show jugular vein prominence, and the arm/leg photos show pooling and discoloration that occur when I’m upright. These vascular changes are positional, for example if I raise my arm up, the color goes back to normal. Has anyone else experienced this?
Neck right side swelling it is not always this bad but never gone
Neck Left side this started in September last year, you can see it move in and out at the base of my neck, gets worse as the day goes on, the longer I am upright
This image is from July 24 left arm, at this point they turn almost purple and the veins bulge when resting, if I raise my arm they go back to normal and the bulging disappears.
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When you say “jugular vein prominence” what do you mean - compression, engorged, backed up? I don’t see any compression of your IJVs in the CT or the 3D constructed 3D. Which only leaves us with them being engorged/backed up. This could occur from them being compressed near the bottom by the clavicles. I just don’t see much or any compression happening up top from the styloids, and it they were, the IJVs wouldn’t be prominent, they would be the opposite.
The lumps that are on the surface of your neck are not your IJVs or any vascular structures for that matter - they are your platysma muscle. We all have these. I labeled your platysma on one of your photos, and I drew where your IJV would be if it were to stick out through your skin. IJV is almost impossible to show through the skin because the SCM muscles covers it.
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Thanks for taking the time to mark that up. I just want to clarify a couple things for context:
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How “jugular vein prominence” is being framed
You narrowed the term to mean only one thing (compression vs. engorgement vs. backup). In reality, all three can occur together — compression at one point can cause backup/engorgement upstream, which is exactly why vascular specialists order dynamic CTVs. -
Where the oversimplification comes in
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“The IJV wouldn’t be prominent if compressed up top” → That’s not accurate. Styloid or C1 compression frequently causes narrowing at the point of contact with visible bulging above. This was specifically noted by the Stanford neurosurgeon who reviewed my 2025 cervical MRI.
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“IJV is impossible to see through the skin” → In thin patients or with positional changes, the IJV can absolutely become visible. Jugular vein distension exams are a standard bedside tool. In my case, my PCP directly documented visible jugular prominence in their exam notes.
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Platysma vs. vein → Platysma does create ridges, but it doesn’t explain positional swelling, discoloration, or the physician-documented venous congestion I’ve had.
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Thanks for this! Not a radiologist or doctor, so I can’t argue with a Stanford neurosurgeon. Regardless of compression or not, I think those styloids are causing issues with them being around 5cm. Hopefully you can get them dealt with!!
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Just to clarify — the CT neck/face you referenced is from Feb 2023. The Stanford neurosurgeon reviewed my 2025 cervical MRI and noted compression at the styloid/C1 level that wasn’t clear on the older scans. My symptoms have also progressed since then, which is why updated imaging is so important.
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