Wow, thanks for sharing - how interesting! I’m sorry about the headaches and everything else - like you said, no wonder we experience symptoms. I really hope you’ll be able to find a doctor soon who won’t dismiss you and can help you come up with a good treatment plan. 
Please keep us updated!
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I’m not sure either what the extra piece is at the end of your styloid. When I zoomed in it looks like it’s a little behind your styloid, I’m guessing maybe it’s a piece of calcified stylohyoid ligament, The other point of curiosity is the thin line crossing your IJV just below the compressed area. I’m guessing that’s a small vein or artery & though it doesn’t appear to be causing a problem in your imaging, It would be very worthwhile addressing its presence w/ Dr. Hepworth to get his take on it. We’ve had members who’ve had trouble w/ partial compression of the IJV by another small vein or artery & sometimes the accessory nerve but nerves aren’t typically visible in CTs w/ contrast.
I annotated the styloid/s-h ligament calcification w/ a circle & added an arrow to point out the unknown vascular tissue which is crossing your IJV below the compression.
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That little extra piece is weird, like @Isaiah_40_31 says, maybe a bit of ligament… It would be interesting too to ask Dr Hepworth about your left IJV, which doesn’t seem to be visible on your scan- lots of people have one smaller / hypoplastic IJV, & very occasionally only one. With both cases if there’s compression of the other IJV then the effects will be felt more…
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Thank you for taking a look at it and the annotations! I think everything you suggested seems reasonable to me. I’ve seen that so many of us have had to do our own research to have an idea of what is going on. It seems like the radiologist reports often leave quite a bit out! Honestly I’m pretty anxious/eager for my appointment, so I’ll be glad to get a little clarity at least.
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@Jules Funny enough, the impression on my report said my right IJV was “unremarkable” but my left one was causing trouble.
“Chronic occlusion of the left internal jugular vein at the level of the jugular bulb with reconstitution via collaterals at the level of C5. The right internal jugular vein is patent and unremarkable.”
It was when I saw NP Alison at Dr. Hepworth’s office that she said the right one was also compressed. She said the left one disappears in some areas and the right one is also compressed. I’ll be interested to figure out whatever else is going on!
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Make sure to ask Dr. Hepworth to show you in the imaging where your left IJV “disappears” & explain what could be causing that. Also have him point out where the compression is in your right IJV & discuss possible cause(s).
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@Isaiah_40_31 I definitely will!! Hopefully I will have a positive update in about a week or so!
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@Isaiah_40_31 was there a particular reason why you suggested Dr. Cognetti? Was it because he seems to help out Canadians quite a bit with ES - and he does decent pricing? I’m open to other surgeons as well, and I see the surgeon list on the forum, but was just wanting to hear your opinions of Dr. Cognetti vs other options (just thought I’d do some more digging while waiting for his office to call me to book a consult)? Thank you!!!
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I suggested Dr. Cognetti because he’s one of the most experienced & longest term ES surgeons we’ve had on our Doctors List. The majority of his patients have had good outcomes (remembering that no doctor has 100% perfect surgical outcomes).
I joined this forum in 2014, & he was one of the doctors most often being recommended even back then. The fact that he offers a more reasonable cash price for those w/o medical insurance or who travel from abroad is icing on the cake. I think also the fact that he has taken on vascular ES now thus expanding his ES surgical horizons shows he understands the multiple dimensions of ES & is invested in helping patients w/ all known forms of ES. Some of the other surgeons whom we’ve had on our Doctors List for that long have not done so.
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That all makes great sense. Thank you @Isaiah_40_31 !
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finally got some 3D CT images to share with you all. Tried measuring my styloids as well. Left side the IJV is not present because there isn’t any contrast in it. Left side tip of styloid looks to be grazing my external carotid artery. Right side I think we see the IJV pinch and tip again grazing the external carotid artery. I think the IJV compression is causing my pressure headaches, and perhaps a combo of the IJVs and external carotids causing my dizziness and ear symptoms? Also appears I have pretty mild calcification on my right lesser horn of the hyoid?
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@TML - Nice job on your images! You have a situation I haven’t seen before & since I’m not a doctor, I can only mention what I see & can’t say if it’s a problem or not. Your right IJV appears to have fused to your rt carotid artery at the carotid bifurcation. I suppose that could cause symptoms of IJV compression though your IJV doesn’t appear to have compression to me except possibly lower down near your thyroid.
On your left side, the greater horn of your hyoid looks to be pressing into the carotid bifurcation & the transverse process of C2 looks like it might be putting some pressure on your ICA. This observation aligns w/ possible carotid compression as there’s a slight bulge in the common carotid artery below these points. It is possible that the greater horns of your hyoid are a bit longer than normal as well. Dr. Cognetti could confirm or deny this.
You have slight bilateral calcification of both your lesser hyoid horns.
You may have some loss of your lordotic cervical curve though your cervical spine looks good in a couple of the images & in a couple it looks very straight so I’m not sure about this but it is a problem among a number of our members.
As far as your IJVs go, in the image of your left styloid, there appears to be a good amount of space between the TP of C1 & your styloid. It’s not as easy to tell on the right as in one image the space looks pretty narrow but in the other it looks adequate to accommodate the IJV w/o compression. I think your bigger problem is the interesting prospect of IJV/Carotid fusion on the right & the possible compression of your carotid on the left. I must say again, I’m not a doctor so perhaps what I see as possible problems are nothing significant, but it would be interesting for you to get an official medical opinion on what I’ve pointed out.
My intention isn’t to alarm you but to inform you. Please take my opinions as just that, opinions, not diagnoses, & nothing to be alarmed about.
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Thanks for all this @Isaiah_40_31! Very interesting. I went through the axial imaging to see if I could look into some of this more. I think what looks like fusion of right ijv/carotid is actually the IJV branching off into another vein system or something, and it just looks fused in the 3D model.
I think there is less space between C1 and left styloid than we think. The axial view shows the left IJV quite pancaked between C1 and the styloid (measured space to be about 4-4.5mm).
My hyoid definitely seems to be causing some of the issues. I’ll be interested to hear what Dr. Cognetti says about it!
Also, I think the right IJV compression we see lower (around c6ish?) looks like it could be the SCM as the culprit?
In the first image, both IJVs look compressed, L more than R but in the second image, the R IJV looks ok. It’s probably the level of the slice that makes the difference.
Good observation regarding the lower IJV compression. The SCM can be a problem for the IJV though I’ve never heard at what level compression is seen. I’m just aware that it exists.
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Nice lordotic curve!! It’s rare to see one that perfect on our forum! You can be our lordotic curve poster person!!
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I think so too! I’ll be sure to ask Dr. Cognetti about both the potential role of my styloids and hyoid greater horns. Thanks for looking at my images! 
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Hahaha!! Well that’s good to hear. One less problem to have lol
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I agree that there’s quite a bit going on in your images! Lots to ask Dr Cognetti about, I can’t really add in any more to what you & @Isaiah_40_31 have already discussed…I would ask him too about the thyroid cartilage & the compression at that level.
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