Sonography of the Large Neck Vessels and of Tumors with Suspected Infiltration of the Large Neck Vessels

  • Hans J. WelkoborskyEmail author


Exact knowledge of vascular anatomy and vascular ultrasonography is crucial for head and neck surgeons. Blood vessels in the neck can be altered either by diseases of the vessels (e.g., atherosclerosis, thrombosis, malformations) or by tumors in the neck. Furthermore, some diseases show characteristic vascular sonographic pattern. This chapter demonstrates vascular anatomy, sonographic, and Doppler/duplex sonographic characteristics of particular vessels. Sonographic criteria of atherosclerosis and carotid artery stenosis are also detailed, as well as infiltration of large vessels in the neck by a given tumor.


Vascular ultrasonography Doppler sonography Duplex sonography Atherosclerosis Carotid artery stenosis Vessel infiltration Dynamic sonopalpation 

Supplementary material

Video 10.1

Transverse and axial sections of the internal jugular vein without and with Valsalva maneuver; the vessel enlarges significantly so that it can be identified easily (WMV 2487 kb)

Video 10.2

The arteries display a systolic pulse and no diastolic pulsations, whereas the internal jugular vein displays a larger systolic pulse followed by a diastolic pulse with small amplitude (“double pulse”) (WMV 3004 kb)

Video 10.3

Color-coded duplex sonography and Doppler spectrum of the common carotid artery (CCA), internal carotid artery (ICA), and external carotid artery (ECA) (WMV 1318 kb)

Video 10.4

Vascularization and peak systolic velocities in small tumor vessels assessed by color-coded duplex and Doppler sonography (MOV 1909 kb)

Video 10.5

Moderate to severe carotid artery stenosis. Note the atherosclerotic plaque inside the vessel’s lumen, with increase of systolic blood flow velocity in the poststenotic segment and deceleration of systolic flow velocity in the prestenotic segment (M4V 959 kb)

Video 10.6

Septic internal jugular vein thrombosis (Lemierre syndrome). The thrombus displays as a hypoechoic mass inside the vessel’s lumen (WMV 465 kb)

Video 10.7

Dynamic sonopalpation: the tumor is visualized on the ultrasound screen (a) (MOV 2336 kb)

Video 10.7

Dynamic sonopalpation: the tumor is visualized on the ultrasound screen and is then moved by the examiner’s hand under direct view (b). It is documented whether there is a shifting of the vessel toward the tumor, which indicates that the vessel is not infiltrated and the tumor can therefore be resected with little risk to the vessel (MOV 24104 kb)

Video 10.8

Allen test. The video shows a significant blood flow in the profound palmar arterial arch during compression of the radial artery prior to harvesting a microvascular forehand flap (MOV 916 kb)


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryKRH Nordstadt Clinic–Academic HospitalHannoverGermany

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