Reverse jugular flow in a case of thrombosis of the brachiocephalic vein with an artificial arteriovenous fistula

Sonology Demonstrates Flow Reversal Within Internal Jugular Vein Secondary to Occluded Innominate Vein and Stenotic Hemodialysis Arteriovenous Fistula

This case illustrates a rare finding of flow reversal within the internal jugular vein associated with innominate occlusion and ipsilateral arteriovenous fistula. The patient was an adult male who presented with extreme pain and swelling of the left upper extremity and an ipsilateral nonfunctioning hemodialysis shunt. Doppler waveforms demonstrated turbulence and retrograde flow of the internal jugular vein (IJV). Sonography demonstrated complete occlusion of the left innominate vein. Angiography confirmed the IJV flow reversal and the full extent of the innominate vein clot. Angiography also showed bilateral indwelling innominate stents, as well as visualized the retrograde flow from the IJV crossing left to right via the transfer sinus and descending caudally to the right IJV. As demonstrated in this case, ultrasound works well in tandem with special procedures.

Visualization of venous systems by time-of-flight magnetic resonance angiography

BACKGROUND AND PURPOSE

Time-of-flight (TOF) imaging technique depicts strong signal from fresh unsaturated magnetization that moves fast into the imaging region, and TOF magnetic resonance angiography (MRA) visualizes the arterial system using saturation pulse and band. However, TOF MRA can visualize the venous system when the flow direction is reversed.

METHODS AND PATIENTS

We consecutively enrolled patients between June 2002 and February 2003 with an internal jugular vein (IJV) and sigmoid sinus (SS) visualized by TOF MRA. Carotid Duplex ultrasonography was performed on all patients to check IJV flow directions. Gadolinium (Gd)-enhanced MRA and conventional digital subtraction angiography were performed in selected patients.

RESULTS

The IJVs and SSs of eight patients (left = 7, right = 1) were observed by TOF MRA. In these 8 patients, Duplex ultrasonography confirmed a reversed direction in IJVs. Four of the patients underwent Gd-enhanced MRA, which showed proximal innominate vein steno-occlusion.

CONCLUSIONS

This is the first description of IJV and SS visualization by TOF MRA. Clinical implications are discussed.