Radiographic procedure for the examination of jugular veins and its tributaries

1. JUGULAR VENOGRAPHY
Presenter:- Saru Gosain
Year:- 3rd year (2017 batch)
Roll no:- 112

2. ANATOMY
• From the confluences of sinuses, the transverse sinus passes laterally and anteriorly
to the base of the petrous part of the temporal bone.
• It then becomes the sigmoid sinuses which lies in the sigmoid sulcus of the
temporal bone, curving downward and medially to the jugular foramen.

3. INDICATIONS
• Evaluating the presence or extent of tumors like glomus tumor,
neurofibroma, neurilemoma, chordoma and metastasis in the
region of the jugular fossa
• Unexplained jugular foramen syndrome
• Useful in the assessment of the presence or extent of neoplasms
in the area of the jugular foramen.

4. TECHNIQUE
• The sedated patient is placed in the supine position with a pillow
under the shoulders and the head tilted back.
• The skin is marked at the intersection of the common carotid
artery and anterior border of the sternocleidomastoid muscle.
• The vein is distended by occluding its distal pert manually or with
traction applied to a rubber or plastic sling.

5. TECHNIQUE
• Using local anesthesia the skin is punctured at the marked with an
18G thin wall needle.
• The vein, which is about 2 cm, lateral to the carotid artery, is then
punctured and when there is free backflow of blood, a 0.035 inch
guide wire is carefully advanced a few centimeters under
fluoroscopic control.
• A polythene 240 catheter is then inserted and small injections of
contrast material are made manually to check for obstruction and
proper catheter position.

6. TECHNIQUE
• The catheter may find its way into the common facial vein, in
which case it has to be withdrawn and redirected up the jugular
vein.
• If no obstruction is encountered, the catheter tip is placed in the
jugular bulb and 40 cc. of meglumine diatrizoate (60 percent
renografin) is injected manually or with a mechanical injector set
at a low pressure.
• The vein must e compressed distally during the injection so that
the contrast material will reflux into the dural sinuses.

7. TECHNIQUE
• Three roentgenograms are taken in rapid succession.
• The Towne projection is used for the frontal studies and the head
is rotated slightly for the lateral studies to separate the two
transverse sinuses.
• Stenver’s views may also be obtained if desired.
• Following the examination of the roentgenogram, the catheter is
removed and the puncture site is compressed for several minutes.