I finally got the CT scan done and it’s given me some new and really interesting insights. Now I have a clearer idea of what’s causing my symptoms and what to do next, but it’s also raised some new questions. At first, the radiologist was unsure why I needed the CT, but once he saw the images, he said he’d never seen anything like it before.
Firstly, yes, I do have severe compression of both internal jugular veins, with the right side being worse than the left, just as I suspected. On the right side, it looks like styloid, or more precisely ligament calcification, is playing a role at the compression in conrast to the left side, where it doesn’t contribute to it. There is a small calcification further down on the left side, but it appears to be insignificant
I went through the CT images in detail:
Right Side:
The right IJV is clearly compressed. It seems like the transverse process of C1 and the calcified ligament are the main contributors to the compression on this side.
It’s hard to tell if the styloid and the calcification are fused together or if there’s some ligament in between. Maybe there is some contact with the artery at the tip of the calcification, especially with head movement.
Left Side:
On the left side, the short styloid doesn’t seem to play a role. The transverse process of C1 seems to be the issue here, with compression happening at two different angles. The upper compression (marked by the upper arrow) is at the “bridge” where the vertebral artery passes through, though this bridge doesn’t appear completely ossified like on the other side.
Here’s another view without the IJV visible:
It also seems like the internal carotid artery (green arrow) is closer to the IJV on the left side, which further narrows the space. I’m worried about potential irritation of the vagus nerve here, as it seems quite tight and the nerve has to pass through this narrow space.
Another thing that became clearer is that some vertebrae are noticeably rotated and not aligned well, which likely contributes to the compression:
When looking up from under the chin towards the atlas, you can see how everything is rotated. The transverse process of C1 on the left (right side of the picture) is rotated towards the IJV, while on the right side (left side of the picture), it’s rotated away. However, the styloid comes into play and narrows the space on the right side. Also the rotation explains why the compression of the left IJV without a styloid happens at all:
Overall, it seems a styloidectomy for the calcification on the right side could benefit me. It’s also clear I need to work on my alignment and posture. Right now, if I try to correct the rotation of the atlas, it might worsen the compression of the IJV on my right side, because the TP would be rotating towards my IJV. So, maybe the styloid is even causing the misalignment of the atlas.
My hyoid bone doesn’t seem to be a problem gladly.
Other observations with likely no medical significance:
- Arcuate foramen (already known)
- Right vertebral artery is hypoplastic
- Initially, I thought there were significant calcifications under my right clavicle, but it’s probably just contrast agent accumulation (I hope), following the vein’s path after injection into my right arm:
Also, it seems I have an anatomical variant where my left facial vein/common facial vein drains directly into my subclavian vein instead of into the IJV. It almost looks like I have an extra IJV (green arrows):
I’m not sure why it seems to end at the bottom and if this causes any issues. This vein could explain why I get facial swellings with cervical collars and maybe even when looking down, suggesting it might get kinked and compressed.
I also had an ultrasound of both IJVs, which didn’t show any abnormalities. Unfortunately, the practitioner probably couldn’t reach the stenosis point since it wasn’t visible on his screen, so he couldn’t detect any high flow velocities.
I want to thank @TheDude a lot for his huge help, providing the adress of the radiology, scheduling the ultrasound, and even making coffee at his place.
My next step will be to try to improve my posture, strengthen this area to aid stabilization, try out medications like blood thinners, and explore other options (for example, nicotine patches seem to really help with symptoms somehow). I will also try vagus nerve stimulation to see if it does change something. I may also consider prolotherapy for the ligaments of the cervical spine and I will think about surgery or contact surgeons in Germany.
