Weird to say this but I'm SUPER relieved my jugular ultrasound is in fact ABNORMAL! YAY!?

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Anybody else have jugular compression at the level of the carotid bulb and foramen???

I haven’t talked to any Eagle’s specialists about these result yet… I am happy to see that compression may not be happening at the level of C1. Right now, I am so curious how many of my symptoms could be explained by the compression this imaging has now confirmed. I am pretty new to Eagles so still trying to learn about this stuff.

My full report is pasted below for any fellow nerds or anyone in the know about Eagles who is interested. Thanks for any constructive feedback!

“Cedars Sinai VASC US ARM VEIN DUPLEX DVT BILATERAL LOCATION: S Mark Taper Foundation Imaging Center

10/6/2025 10:30 AM

DESCRIPTION: Color flow duplex sonography of the bilateral upper extremity venous system was

performed utilizing both compression and spectral Doppler analysis

CLINICAL INDICATION: Evaluate Eagle’s Syndrome.

RIGHT ARM AND NECK DOPPLER:

Jugular: Normal Doppler.

Innominate: Normal Doppler.

Subclavian: Normal Doppler.

Axillary: Normal Doppler.

RIGHT JUGULAR VEIN DIAMETER AP x TRV:

Jugular vein base of neck: 8.0 x 13.2 mm

Jugular vein SCM: 7.5 x 14.0 mm

Jugular vein carotid bulb: 4.9 x 10.5

Jugular vein C1: 6.9 x 5.1 mm

Jugular vein foramen: 5.8 x 8.1 mm

RIGHT JUGULAR VEIN VELOCITY:

Jugular vein base of neck: 51.4 cm/s

Jugular vein SCM: 41.5 cm/s

Jugular vein carotid bulb: 78.3 cm.s

Jugular vein C1: 14.0 cm/s -diminished flow

Jugular vein foramen: 67.0 cm/s

LEFT ARM AND NECK DOPPLER:

Juglar: Abnormally continuous Doppler, suggesting proximal venous obstruction.

Innominate: Normal Doppler.

Subclavian: Normal Doppler.

Axillary: Normal Doppler.

LEFT JUGULAR VEIN DIAMETER AP X TRV:

Jugular vein base of neck: 8.7 x 8.9 mm

Jugular vein SCM: 9.7 x 6.0 mm

Jugular vein carotid bulb: 3.1 x 4.9 mm - narrowing

Jugular vein C1: 8.3 x 3.1 mm

Jugular vein foramen: 2.6 x 4.2 mm - narrowing LEFT JUGULAR VELOCITY:

Jugular vein base of neck: 53.3 cm/s

Jugular vein SCM: 62.0 cm/s

Jugular vein carotid bulb: 16.3 cm/s

Jugular vein C1: 25.1 cm/s

Jugular vein foramen: 22.6 cm/s

Notes: Technically difficult exam due to patient pain at site of exam.

IMPRESSION: Abnormal exam.

RIGHT: Normal.

Jugular: The extracranial jugular vein is easily compressible with flow noted throughout by color and spectral Doppler. There is no evidence of deep vein thrombus. The jugular vein does not appear to be compressed between sternocleidomastoid and omohyoid muscle. The jugular vein does not appear to be compressed at the level C1. The jugular vein does not appear to be compressed at the level of the foramen.

Innominate: The visualized portion of the innominate vein is patent and without thrombus.

Subclavian:The subclavian vein is patent and without thrombus.

Axillary: The axillary vein is patent and without thrombus.

Brachial: The brachial vein is patent and without thrombus.

Basilic:The basilic vein is patent and without thrombus.

Cephalic: The cephalic vein is patent and without thrombus.

LEFT: Abnormal: The jugular vein does appear to be compressed at the level of the carotid bulb and foramen. Suggest further clinical evaluation if clinically warranted.

Jugular: The extracranial jugular vein is easily compressible with flow noted throughout by color and spectral Doppler. There is no evidence of deep vein thrombus. The jugular vein does not appear to be compressed between sternocleidomastoid and omohyoid muscle. The jugular vein does not appear to be compressed at the level C1. The jugular vein does appear to be compressed at the level of the carotid bulb and foramen.

Innominate: The visualized portion of the innominate vein is patent and without thrombus.

Subclavian:The subclavian vein is patent and without thrombus.

Axillary: The axillary vein is patent and without thrombus.

Brachial: The brachial vein is patent and without thrombus.

Basilic:The basilic vein is patent and without thrombus.

Cephalic: The cephalic vein is patent and without thrombus.

COMPARISON: There are no prior exams performed at the S. Mark Taper Foundation Imaging Center Vascular Lab for comparison.”

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I’m not sure if it’s me being a complete wally, but my first impression reading this is that the conclusions of the report actually contradict the findings?
It says right jugular vein velocity ‘Jugular vein C1: 14.0 cm/s -diminished flow’,
‘Jugular vein foramen: 2.6 x 4.2 mm - narrowing LEFT JUGULAR VELOCITY’ , so to me that would imply there is also narrowing at the C1 level on the right, and at the jugular foramen on the left?
It would be helpful to find out whether you have an abnormally small jugular foramen on the left which would restrict blood flow out of the head, or whether the styloid process is causing this narrowing, as the styloids are right next to the jugular foramen, & a wide process or angled one could potentially cause issues, although if it is an abnormality with the actual foramen then there’s nothing which could be done about that…

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@Glitterbats did they have you turn your head left and right to repeat the readings?

It was just a couple weeks ago I was reviewing CT imaging for a forum member (who has CCI) and they had two CTs that I was able to compare. In one CT their right styloid was a healthy distance from C1, but in the more recent CT the styloid was actually jammed against C1. In other words, I think because she has CCI, the styloid-C1 space can change dramatically with a simple head turn (I suspect due to ligament laxity). The styloid-C1 distance changes in those without CCI as well (in which we often see severe compression with left or right movements), but it seems to be more exaggerated in context of CCI.

I’m glad they found something abnormal regardless so that you have some explaining for your symptoms (in addition to your CCI)

I’m trying to find the forum thread but I’m having difficulties remembering who the member was.

Edit: I found the forum thread

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I’m kindof confused by this question. The report I posted is from a jugular ultrasound/ not a CT. I haven’t posted my CT report or images here. This jugular ultrasound took like an hour to complete, included many images and was done with my head mostly straight as well as slightly turned to the right or left. Because I have some discomfort with head turning( which I expressed to the tech), I’m pretty sure she ended up barely asking me to do it for the majority of the test( although there was some in the beginning).

It’s pretty known that distances between these structures change based on position, so I’m not really understanding what that has to do with my ultrasound or what the ultrasound report has to do with that other patients CT.

Also, I have been formally diagnosed with May Thurber and Dysautonomia/ tachycardia in addition to CCI and now jugular compression has been re-confirmed, so this isn’t my only other abnormal test result/ explanation for my current symptoms.

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So, that is true that there was some diminished flow noted on the right at the level of C1 but my interpretation was that since that was the only slight abnormality on the right side, that the right side side was still considered within normal range?( I don’t know for sure though yet). I have allot of muscular tension on the right side of my neck for example as it is likely trying to compensate for what’s happening on the left, so I wouldn’t be surprised if there’s just something more benign causing that on the right, whereas on the left, things are legitimately bad and obstructed.

How would the convulsions contradict the findings? Mostly because of the diminished flow on the right near C1?

That’s scary about the prospect of an abnormally small jugular foramen and I don’t know for sure if I do or don’t have that. I mean… my styloids have already been identified as calcified and the compression is happening right at the level they would be at, so I’m leaning towards that atm.

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I was asking if they had you turn your head left and right for the ultrasound, in addition to looking forward. Because I didn’t see any mention of repositioning (i.e., having you look to the left and to the right) in the report that you posted. The measuring of IJV diameter and velocity in the context of ES typically involves having the patients remeasured in the three positions (forward, left, and right). - having IJV diameters and velocities for each of the three positions at every relevant level of the IJV.

What I’m trying to say is that your IJVs may actually become compressed between C1 and styloids with your head turned. Which is the reason I asked about head positioning. I just didn’t see it mentioned in the report. I can only imagine how tough it would be to fully turn the head though with CCI. Makes things trickier.

And yes, styloids moving when the head moves is obvious and often fine in a healthy individual, but it typically results in IJV compression at the level of C1 in those with ES, which is why some people with ES get the ultrasound in the first place - there symptoms are worse with head movement and so they need to get the diameter and velocity differences for each movement.

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@Glitterbats -

I think what @Jules was referring to as a contradiction in your report is that the study showed Right Jugular flow reduced at C1 but the conclusion stated that the Right IJV is normal. Reduced flow indicates compression which demonstrates some level of flow obstruction which we would not consider normal, however, we aren’t doctors so can only speak from our experience on this forum.

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Yeah, I don’t know. I just had a follow up appointment with NP Alison Love and she said the right side looked pretty good overall/or at least she only recommended surgery for the left side.

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I guess my head wasn’t really turned for it. There was just a part of the test at the beginning when the tech was getting the hang of it, where I was slightly angled a tiny bit to the right but pretty much all the other images were taken with me just facing straight.

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