Incidence of extrinsic compression of the internal jugular vein in unselected patients undergoing CT angiography.

Background And Purpose: Little is known about how commonly the internal jugular vein is compressed by extrinsic structures in the upper neck. The purpose of this paper was to identify the frequency and cause of external compression of the superior segment of the internal jugular vein.

Materials And Methods: Retrospective review of CT angiograms of the neck was performed in 108 consecutive patients. Axial source images were evaluated for moderate (>50%) or severe (>80%) stenosis of the internal jugular vein on the basis of external compression. The cause of extrinsic compression was also recorded. In cases with stenosis, the presence of ipsilateral isoattenuated collateral veins was recorded and considered representative of collateral flow.

Results: Moderate stenosis was seen in 33.3% of right and 25.9% of left internal jugular veins. Severe stenosis was seen in 24.1% of right and 18.5% of left internal jugular veins. The most common causes of extrinsic compression included the styloid process and the posterior belly of the digastric muscle. In patients with severe internal jugular vein stenosis, 53.8% of right sides and 55% of left sides had associated condylar collaterals.

Conclusions: Extrinsic compression of the superior segment of the internal jugular vein is a common finding in unselected patients, often caused by the styloid process or the posterior belly of the digastric muscle. Presence of severe stenosis is not universally associated with collateral formation.