Internal jugular vein (IJV)

External jugular vein (EJV)

Retromandibular vein (RMV)

Major extracranial venous system composed of facial veins, neck veins, scalp, skull (diploic), and orbital veins

Facial veins

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  Facial vein

  
  
  
  
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    Begins at angle between eye, nose

    
    
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    Descends across masseter, curves around mandible

    
    
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    Joins IJV at hyoid level

    
    
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    Tributaries from orbit (supraorbital, superior ophthalmic veins), lips, jaw, facial muscles

  
  
  
  
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  Deep facial vein

  
  
  
  
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    Receives tributaries from deep face, connects facial vein with pterygoid plexus

  
  
  
  
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  Pterygoid plexus

  
  
  
  
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    Network of vascular channels in masticator space between temporalis/lateral pterygoid muscles

    
    
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    Connects cavernous sinuses and clival venous plexus to face/orbit tributaries

    
    
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    Drains into maxillary vein

  
  
  
  
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  RMV

  
  
  
  
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    Formed from union of maxillary and superficial temporal veins

    
    
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    Lies within parotid space

    
    
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    Passes between external carotid artery (ECA) and CNVII to empty into IJV

  
  

Neck veins

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  EJV

  
  
  
  
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    From union of retromandibular and posterior auricular veins

    
    
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    Courses inferiorly on surface of sternocleidomastoid muscle

    
    
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    Drains into subclavian vein in supraclavicular fossa

    
    
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    Receives tributaries from scalp, ear, and face

    
    
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    Size, extent highly variable

  
  
  
  
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  IJV

  
  
  
  
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    Caudal continuation of sigmoid sinus from jugular foramen at skull base

    
    
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    Jugular bulb = dilatation at origin

    
    
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    Courses inferiorly in carotid space posterolateral to internal/common carotid arteries underneath sternocleidomastoid muscle

    
    
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    Unites with subclavian vein to form brachiocephalic vein

    
    
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    Size highly variable; significant side-to-side asymmetry common; right usually larger than left

  
  
  
  
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  Subclavian vein

  
  
  
  
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    Proximal continuation of axillary vein in thoracic inlet

    
    
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    EJV drains into subclavian vein

    
    
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    Subclavian vein joins IJV to form brachiocephalic vein

  
  
  
  
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  Vertebral venous plexus

  
  
  
  
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    Suboccipital venous plexus

    
    
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    Tributaries from basilar plexus, cervical musculature

    
    
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    Interconnects with sigmoid sinuses, cervical epidural venous plexus

    
    
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    Terminates in brachiocephalic vein

  
  

Low pressure inside; easily compressible

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  Light probe pressure with good surface contact between transducer and skin to ensure optimal visualization

  
  
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  Valsalva maneuver helps to distend major neck veins

IJV

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  Largest vein of neck

  
  
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  Deep cervical chain lymph nodes commonly found along its course

  
  
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  Beware of thrombosis in patients with previous central venous catheterization or adjacent tumors

  
  
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  Always check for compressibility and phasicity on respiration

  
  
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  Vascularity in IJV thrombosis usually seen with tumor thrombus rather than bland venous thrombus

Subclavian vein

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  Accessible on US by inferior tilting of transducer in supraclavicular fossa

  
  
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  Venous valves present in most patients

  
  
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  Thrombosis/stenosis commonly seen in patients on chronic hemodialysis or with previous subclavian venous catheterization

RMV

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  Serves as landmark on US to infer position of intraparotid portion of facial nerve

  
  
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  Anterior division of RMV sandwiched between submandibular gland anteriorly and parotid tail posteriorly

  
  
  
  
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    Its displacement helps to determine origin of mass in posterior submandibular region

  
  

Neck veins often overlooked as most sonologists pay more attention to arteries than veins in neck

Not all neck veins readily assessed by US

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  Only large and superficial veins clearly seen

Asymmetric IJVs common; 1 IJV may be many times the size of contralateral IJV

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  IJV venous varix: Extreme dilatation of IJV upon Valsalva maneuver with clinically palpable neck lump

Slow flow within IJV may appear as low-level, hyperechoic intraluminal “mass”

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  May mimic IJV thrombus

  
  
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  Moving nature of echoes on real-time US and sharp linear near-field interface help to distinguish artifacts from slow flow and IJV thrombus

US safely guides needle for venous access

Absence of respiratory phasicity is strong indicator of abnormality